Increasingly, choosing a Pharmacy Benefit Manager (PBM) has become a performance-based decision for Employers, Insurance Carriers, and TPAs. As Third Party Billers continue to gain the allegiance of many pharmacies seeking to not honor W/C PBM service providers in pursuit of higher profits, Payers are bearing the burden of increased cost for paper claims processing, bill review expense, and ultimately a significantly increased expense for prescription claims adjudicated at fee schedule or above. Now, more than ever, choosing the right PBM is crucial.
In order to control overall rising drug costs, payers have realized savings through partnering with pharmacy benefit managers (PBMs). Today, addressing the challenges of improving “true” prescription capture rates, managing utilization, addressing the problem of Third Party Billers, proactively managing physician prescribing patterns, and ultimately making available usable cost saving data reports are all keys to choosing the best PBM.
Integrated Prescription Solutions’ pharmacy program stands in a class of its own when it comes to delivering pharmacy management services to its clients. Our Best in Class solutions include:
- Prescription Capture Rates. IPS guarantees a 90+% capture rate within 150 days of client set-up.
- Retail Pharmacy Network. IPS provides its clients with the largest pharmacy network in the industry representing almost 99% of all US pharmacies, totaling over 65,000+ retail locations.
- Mail Order Facilities. IPS provides five state-of-the-art mail order facilities to best serve the entire United States. Our geo-strategic locations reduce shipping expense and improve home delivery times.
- Pharmacy Network Penetration. IPS is the stand-alone leader in pharmacy network compliance. Through strict pharmacy network agreements and prompt network reimbursement, IPS boasts a 99.9% penetration rate from its network pharmacies.
- Third Party Bill Management. The IPS program takes a proactive approach with direct pharmacy contacts to ensure the pharmacy has all of the claimant drug card information. When possible, the pharmacy may choose to correct the billing information and redirect the prescription back into the IPS discount program. Additionally, IPS’s unique first fill solution “Temp Card™”, along with the timely issuance of a permanent drug card, eliminates future out-of-network prescription expenses. As a result, IPS guarantees its clients to reduce third party bills to less than 10% in 150 days of client start up.
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Managing Utilization. Recognized as one of the “key” cost drivers for overall prescription drug expense, IPS provides proprietary clinically-based, real-time software solutions at every POS retail pharmacy location.
- Retrospective Review at POS prevents early refills, alerts on drug-to-drug interactions and excessive dosage prescriptions, and preventing duplicate prescriptions.
- Generic Efficiency Rate. IPS drives cost effective generic fills through its mandatory generic fill contract with its participating pharmacies resulting in the highest generic efficiency rate in the industry at 92.7%.
- Physician Face-to-Face pharmacist contacts. IPS is the only PBM that provides more than 350 field pharmacists dedicated to direct communication efforts to our client’s prescribing physicians. This program is committed to formulary compliance and driving generic prescriptions.
- Physician Profiling gives our clients a unique comparative look at the metropolitan statistical area of any claimant as well as a national perspective on like-physician prescribing patterns. This program helps our clients “red flag” prescribing patterns not consistent with cost containment program objectives.
- Mail Order Alerts gives our clients quick management reminders when it would be clinically appropriate and cost effective to convert a card holder from retail to mail. Our clients realize additional savings; and members are pleased by the added convenience of 90-day supplies and no waiting in line at the pharmacy.
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