ClaimWatchRx

 

Ultimate Pharmacy Benefit Management Cost Control

Our automated and comprehensive ClaimWatchRx system allows us to provide payers with unbiased and thorough insight into how their claims and overall Rx benefit is being managed by their PBM. Initially, individual contract parameters are created, then raw Rx data files are processed in an effort to find costly outliers and pricing anomalies. That information is then reviewed by our experienced (industry specific) analysts to confirm savings opportunities that may not have been made evident previously.  Our team thoroughly explains the subsequent cost impacts and collaborates with payers to find feasible solutions. ClaimWatchRx, combined with our experience and personal approach, can dramatically improve your ability to understand if and how your PBM is driving your Rx benefits costs down.

Key Features

ClaimWatchRx provides you with reporting that matches your PBM contract parameters. This state of the art platform uses your data and validates your PBM’s reporting by analyzing a diverse and specific variety of cost measures including AWP, MAC pricing, Zero Balance logic and specialty trends, just to name a few. ClaimWatchRx provides access to true transparency for “apples-to-apples” comparisons between pharmacy benefit plans while accounting for PBM pricing adjustments with customized exclusions and inclusions of certain claims. 

We don’t have to tell you about the current price increases in pharmacy benefit costs, because you can see it for yourself in all of your PBM invoices. Not long ago, benefits used to be 5% of total healthcare costs. Now, it is quickly approaching 20%. Indications for the use of costly specialty drugs is on the rise and new drugs are coming to market all the time. Organizations like yours can no longer afford to rely solely on the PBM to manage to their pharmacy benefit spend. With our support and proactive reporting, you could be saving a significant amount starting now. It’s much easier to prevent overspend now than to try to recover it in the future. 

Complex Pricing Schemes and Vague PBM Contracts Create Risk for Your Organization

Pharmacy Benefit cost control is daunting and can feel almost impossible without accurate information and the right tools. We see it every day: PBM contract language that increases a payer’s liability due to the rapid and continuous rise in prescription costs while simultaneously failing to deliver the value you expect and plan for. 

Crystal Clear Rx will act as your advocate and support you throughout the crucial negotiation process. Crystal Clear Rx strives to produce results that deliver up to 15% or more savings through proactive and meticulous analytics and actionable solutions. You don’t have to question or worry anymore that you may be getting short-changed on value. We can help put you back in control.

Take Back Control: Protect Your Interests

ClaimWatchRx provides the intelligence to help level the playing field with your PBM by identifying contract loopholes and making sense of your benefit spend. Oftentimes, we find that payers are blindsided by what the amount of leverage and revenue control their PBM has written into their contract. Some of which does not protect the payer’s best interests and moreover, takes advantage of credulity. 

Our analytics and impartial reporting shine a light on information that PBMs are not likely willing to share. We analyze contract language and audit/monitor your PBMs performance for potentially costly loopholes and discrepancies. Crystal Clear Rx advocates for payers to ensure they enter into a fair contract initially and help to maintain its true objectives throughout the entire length of the agreement. 

All Things Aren’t Equal: Expertise Matters

Our team at Crystal Clear Rx possesses a deep and profound understanding of the complexities involved with PBM contracting. We have decades of experience working on the payer side and the PBM side of healthcare. This combination allows us to be uniquely positioned to help you save time, frustration and most importantly, money.

Find out today how much you could be saving. Contact us today.