Navigate the complexities of government programs with confidence
States have gained power through the ACA and have the potential to implement regulations that impact the operations of pharmaceutical companies and PBMs. Increasing influence at the state-level will further pressure PBMs to modify their business strategies to comply with legislative regulations. Advocacy among PBM leaders is crucial for opening up lines of communication with the state to improve the policies of health reform which could greatly affect the structures of formularies and regulate use of generic products and specialty pharmaceuticals.
PBM management is especially critical given CMS’ focus on drug benefit-related issues, such as prescription drug event reporting and transition fills. Our team performs in-depth compliance assessments to evaluate PBM performance as a delegated entity. We’ll audit your team’s efforts to ensure that your PBM is accurately adjudicating claims on your client’s behalf and reporting accurately to CMS. We’ll evaluate the efficacy of your MTM programs and much more.