Turn Your Benefits Data Into Savings

2021 CCA rules mandate that employers must attest that their PBM fees are "reasonable".

Identifying improper administration is often the greatest opportunity for employers to realize significant savings.

Our approach includes:

• Generating or requesting a report of your top 50 prescription drugs by total spend
• Reviewing the PBM contract using a benchmark to identify excessive or improper terms including 100% rebate pass-through requirements
• Requesting prescription claims data for an audit and assessing compliance before Jan 1, 2027 hard deadline
• Examining the spread- the difference between what was paid to the pharmacy and charged to the plan
• Identify any current rebates withheld or improperly applied

Employees can be straight forward, but sometimes dependents get left on the premium billing schedule even though they didn't elect renewal coverage or are no longer eligible.

We'll review your census, double check enrollments, and issue a report for members who may not be eligible along with managing the premium refund request process.

You may have had good intentions about a wellness program or inherited programs that have been offered for a while. But do employees really use them?

Especially with pepm pricing eliminating these low utilization programs can give a quick savings.

We'll review each vendor in your benefits offering and compare their YTD actual performance with what's in the contract.