PharmaComplete™

The value of a pharmacy program is intrinsically linked to the ability of a service provider to contain costs and minimize out-of-network spend. To capture the full value of using a pharmacy benefit manager, PMSI has introduced a proprietary, comprehensive solution—PharmaComplete. By partnering with industry-leading service providers, this innovative solution addresses high-cost, out-of-network bills throughout the life of a claim through Specialty Network Arrangements, Automated Re-Indexing programs, and Out-of-Network Conversion strategies—positioning PMSI to deliver proven solutions for cost containment.

With PharmaComplete, network penetration can be driven from an industry average of 65% – 75% up to 90%, resulting in greater cost savings and efficiencies. Costs are contained by rates lower than traditional out-of-network bills, administrative savings, benefiting from utilization controls, and creating opportunities for clinical oversight. Broader access and visibility to analytics and informatics of all transactions allows for total management of pharmacy spend with the goal of containing costs while providing quality care. In addition, PMSI’s PharmaComplete solution can be tailored based on areas of out-of-network spend, allowing clients to optimize the performance of their pharmacy program.

• Specialty Network Arrangements – The key to improving penetration beyond the traditional retail pharmacy network is to extend the network to encompass non-traditional dispensing outlets. As a result, PMSI has developed a series of specialty networks that includes direct contracts with physician dispensers, partnerships with two of the country's largest occupational clinic networks and several direct mail pharmacy providers, and a nationwide network of compounding pharmacies.
• Automated Re-Indexing – PMSI has formed industry-leading partnerships with two of the four largest retail pharmacy chains, to automatically adjudicate almost all applicable prescriptions as in-network transactions. This program consistently demonstrates results of 98% in-network penetration and ultimately maximum savings for these pharmacy partners, which make up nearly 40% of all retail transactions.
• Out-of-Network Conversion – Transactions that are not processed correctly through the retail network or one of our prospective PharmaComplete programs result in paper bills for clients. Consequently, PMSI has developed numerous partnerships and has also implemented a state-of-the-art pharmacy outreach program. These combined programs proactively and retrospectively convert transactions to network transactions and achieve results that reduce out-of-network spend in the range of 35 – 45%. For those bills that cannot be converted into network transactions, the final step is our bill review solution that provides average savings of 35% from provider billed charges to Fee Schedule or U&C rates.