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PHARMACY BENEFIT MANAGER – CONTINUOUS MONITORING SERVICES
Continuous Monitoring Service from TFG Partners empowers you to manage your self-funded plan’s pharmacy investments more accurately and in less time than ever before. We combine analytics and oversight in a unique approach that’s second to none. With TFG’s CM monthly reports, you’ll receive actionable intelligence about your pharmacy plan that you or your benefits consultant will find invaluable.
Our cost-effective service focuses on capturing missed discounts, identifying claims with cost issues, and detecting payment errors as they occur. We’ll make you aware of irregularities long before they become million-dollar problems – we’ll also call your attention to every opportunity for improvement. The power and precision of our process immediately identify emerging trends driving your costs.
Have the facts, so you don’t need to depend on vendors or others with potential conflicts.
Independence and our experience make TFG’s Continuous Monitoring Service superior to other options. We are an independent organization that has provided cost transparency and audit service for more than 30 years. We give you precise, unbiased reports about your pharmacy plan performance.
WHY IS OUR CONTINUOUS MONITORING AN EFFECTIVE SOLUTION?
Today’s prescription drug market environment makes it harder to understand how your plan performs, and price irregularities are a daily occurrence. They range from discount shortfalls and rebate discrepancies to reclassification and exclusions by discount class. Our job is to track and report the changes and irregularities as they occur so you stay on top of the situation and can manage effectively.
Capture missed discounts
Review claims with cost issues
Detect payment errors
Avoid missing recoverable overpayments
Improve cash flow
Our Continuous Monitoring solution offers the ongoing review and reporting capabilities you need to control costs and manage them effectively. We screen claims monthly and provide easy-to-read reports at regular frequency during the plan year. CM helps Human Resources and Finance departments drive PBM accountability while providing clear plan performance summary reports for C-Level executives to review.
YOU’LL HAVE THE OVERSIGHT YOU NEED TO MANAGE COSTS
The Continuous Monitoring service covers monthly data capture and validation, reviewing 100-percent of benefit claims along with all billing consolidation, monthly or quarterly online reports, and in-person reports to your team members.
Validate you only pay for what your members use
Track the total number of prescriptions and their cost versus PBM invoices each billing period.
Validate all charges for invoiced fees and services.
Make sure your PBM is delivering all promised discounts and rebates
Validate discounts received by class (brand, generic, specialty) against contracted discount guarantees.
Identify shortfalls that need to be offset for discount shortages, incorrect administrative fees, etc.
Reconcile rebate reporting against rebate-eligible Rx counts annually.
Receive a snapshot of your plan’s cost trends and savings
Compare year to date versus previous year-to-date drug costs, fees (admin, advisory, clinical), and rebate payments.
Evaluate actual amounts and actual amounts adjusted for discount shortfalls.
Identify savings of the current contract against the previous agreement or market check upgrade.
EASY IMPLEMENTATION AND STRAIGHTFORWARD FEES
Start-up for CM service is easy and handled nearly entirely by TFG Partners. Once the service agreement is signed, we work directly with your PBM to establish a secure data exchange. We also load all contractual terms and details into our system and can be read to begin receiving claims and product your first reports within six to eight weeks after kick-off.
As benefit claims come into our system, we will work with your PBM to ensure the review is accurate, accounting for all discount classes often based on drug type and dispensing channels, special exceptions, and your unique pricing arrangements as included contractually.
Billing for the service is based on a straightforward fixed PMPM fee that gets billed at the start of each quarter. The price is surprisingly cost-effective, and, in most situations, it will save your plan more than the cost of the service.
THE REPORTING YOU’LL RECEIVE IS INSIGHTFUL AND ACTIONABLE
- Monthly Status Reports and Quarterly Financial Performance Reviews, designed to keep you informed about progress and any performance gaps. These reports are also available online for your team members, making it easy to access the latest information any time any place;
- Annual Summary Report, covering all TFG Partners findings, including any refunds, offsets, as well as areas of disagreement with you PBM, and a complete exception analysis and detailed findings report;
- Final Annual Recommendations & Closing Requirements Summary, an easy-to-use and exclusively TFG Partners-provided document to help understand key issues, resolutions and to drive improvements and accountability.
WHY IS OUR SOLUTION THE BEST ONE FOR YOUR PHARMACY PLAN?
Our Continuous Monitoring Service is a comprehensive service and a highly effective management tool for your company and its pharmacy plan. We combine insightful analytics with the oversight capability of the most sophisticated claim auditing available in the industry today.
Our service puts you in control by providing you with an entirely objective plan review reported in an easy-to-use and understand format. It’s common for CM clients to see ROIs in the 300 to the 1,000-percent range and members are always better served when plans are managed as effectively as possible.
Claim auditing, monitoring, and reporting are our only business. We are pioneers in the field—many of the processes and methods that today are industry standards originated with TFG Partners. Our PBM CM Service is transformational for self-funded pharmacy benefit plans and their sponsors.
