Our Services
PBM Evaluation, Selection, Contracting and Implementation
Completing an independent assessment to determine the optimal PBM partner for a plan and negotiating the most competitive terms is more critical than ever to ensure the best use of the plan's resources. We develop and administer customized PBM requests designed to meet your specific strategies and goals through a variety of PBM delivery models. FIRST Rx leads the procurement process and completes an actuarial financial evaluation of PBMs’ offerings to provide payors with an accurate comparison on a like-for-like basis. Our team negotiates contract details on client's behalf to hold the selected PBM accountable for operational, service, and financial commitments made during the RFP process. If a PBM transition is needed, FIRST Rx assist clients with implementing the new PBM to ensure timely, accurate, and best-in-class set-up.
Rebate Optimization
The influence of rebates on plan sponsor economics and manufacturer actions has grown signficantly over the past decade. Ensuring that our clients receive each dollar of rebate earned is a core service that FIRST Rx provides. FIRST Rx's experts review claims classified as ineligible towards rebate guarantees to ensure accuracy relative to the PBM's contractual rebate exclusion language. We work with the PBM to remediate errors and provide full payment due to the plan. FIRST Rx provides expert assistance to plan sponsors with evaluating lowest net cost alternatives based on their purchasing capabilities.
Pricing Reconciliation of PBM
In order to ensure our clients' PBMs achieves its financial guarantees for discounts, dispensing fees, and administrative fees, FIRST Rx analyzes PBM performance annually. If any shortfalls are identified, we negotiate and support the collection of remediation payments with the PBM. We leverage lessons learned and areas prone for error to proactively implement safeguards to prevent future errors.
Relentless Program Management
A plan's member experience and financial performance outcomes are heavily influenced through the day-to-day decisions and management of a plan. At FIRST Rx, we believe the details and what happens between renewals and annual budgets matters. We work shoulder-to-shoulder with our clients' teams to actively manage the many aspect of a plan - clinical management programs, plan design, member communications, fulfillment logistics, and ongoing formulary optimization among others - and deliver better financial, clinical, and member experience outcomes.
