CobaltRx's wealth of experience in the pharmacy benefits industry drives us to continually challenge client expectations, providing comprehensive, targeted results to match your goals.
A Performance Report and Plan Overview is our typical first step in assessing the possible shortcomings of your current Rx plan. This is our spring board to a deep understanding of your true needs and what sets us on the right path to crafting you the perfect benefits plan.
We evaluate your current and potential plan performance, and compare that to your financial and clinical objectives, looking for initially obvious mismatches. If your plan lacks a long-term strategy or direction, we'll work with you to formulate a strategic blueprint for the future of your plan. Our process includes:
To provide clarity-driven insight, we’ll integrate and normalize your data to get it report-ready. In doing so, we’ll review the available information detailing pharmacy transactions from your Rx plan and supplement that information with any additional clinical, demographic, administrative or financial information necessary for comprehensive reporting. In addition, we'll review custom ad hoc reporting requirements and use our experience to put together an implementation plan for any custom features you may need added to your dashboard. Once all of your data has been input, we’ll outline a process to update any shared references that could potentially change down the line, such as contracted discounts and rebates or groups added to the platform. Once report-ready, you’ll have the power at your fingertips to make your data work for you.
Equipped with a variety of reports, the following serve as examples of the types of reports we can provide:
To learn more about our consulting services, click the button below to download a copy of our brochure.
The world of pharmacy benefits is dynamic, so why would your plan be stagnant? With an impactful, proactive approach to plan management, we support your plan and help it evolve along with the industry through an experienced team and an industry-leading analytic platform.
We serve as your personal pharmacy benefit specialist, helping to evaluate, modify, design and execute solutions to meet your specific plan goals. Ongoing plan management includes:
In addition to the above services, we continually enhance your plan performance by combining complimentary programs when indicated as beneficial by plan data we collect, aggregate and analyze. By doing so, we seek out solutions to target key areas of opportunity and help better manage plan expenditures. Programs we partner with include:
Our third-party partner helps us to counter the aggressive marketing of pharmacy manufacturers to physicians and end consumers through a no-risk savings program. We use your plan’s data to compile prescription alternatives that provide cost-savings for both the plan and the member.
As the single most costly disease state, Diabetes also exacerbates more diseases than any other condition. Our partner provides high-level insight through real-time monitoring of members treated with diabetes to improve compliance, save plan dollars by preventing catastrophic health events, and strengthen the network of support. In order to manage diabetes at the level of detail it requires, we collect biometric readings via Bluetooth, WiFi and cellular home-based devices and aggregate clinical and financial information into a comprehensive suite of population and risk management reports which include:
Once a specialty drug is approved, our third-party solution manages members on that drug after they have been approved for treatment. To ensure therapy goals are being met, this program:
If your Pharmacy Benefits Manager (PBM) isn’t performing, we want to help. Our in-depth, comprehensive audits can help uncover missteps in plan performance, and keep your benefits plan running smoothly. With the ability and expertise to analyze and uncover your plan’s cost drivers, our experienced team leaves no stone unturned. CobaltRx offers the following types of audits:
Focuses on contract elements like negotiated discounts, MAC list application, dispensing fees, Administrative fees, etc.
Focuses on the proper adjudication of copays, coinsurance, and deductibles.
Focuses on the proper application of prior authorizations, quantity limits, excluded drugs, and step therapy.
Focuses on making sure all adjudicated claims were for eligible members on the data of fill.
Focuses on the financial and procedural accuracy of rebate reimbursement based on the contract.
Validate the service guarantees in the contract, to include: customer service answer times, mail service days to fill and delivery, etc.
Our years of experience working with both good and bad PBM relationships have helped us develop a Request for Proposal (RFP) process that looks beyond the black and white of your situation, and works to find you the perfect PBM partnership.
Your relationship with your PBM is extremely important to achieving the goals of your benefits plan, and through the RFP process, we’ll develop a comprehensive document detailing your wants and needs for potential partners. Working in tandem with you, we’ll prepare a document specifying all needs and establishing an evaluation criteria for received proposals. We’ll then use the RFP document to elicit bids from potential vendors and help you select your new PBM. RFP preparation includes:
