The client desires to partner with an organization to provide Pharmacy Benefit Management Services for their Prescription program. The services shall include, but are not limited to: Electronic, paper, Medicare Secondary Payor (MSP), and Medicaid Subrogation claims processing and payment. Comprehensive and timely support of data files and data feeds to third party vendors, including, but not limited to client’s TPA, Data Warehouse and vendors, such as TruDataRx. Pharmacy network contracting and management Rebate contracting and administration Formulary development and management Clinical support and clinical program management Drug utilization review (concurrent, prospective, retrospective) Step Therapy, Quantity Level Limits, Prior Authorization programs Standard and Ad-Hoc Reporting (monthly, quarterly, and annual performance reporting) Web-based reporting and operational tools. Benefit design and implementation services Eligibility administration Member ID cards (if requested). Note: These are currently managed by the client’s TPA. Dedicated Account and Clinical management team with Executive level sponsorship Toll-free member customer service and toll-free pharmacy help desk Robust member and provider portal Online Coordination of Benefits Pharmacy Network Audits Fraud Waste and Abuse (FWA) Programs Specialty Drug Management Copay Card Manufacturer Assistance Programs (Specialty and Traditional copay card programs as available).
