Tailored Solutions Designed
for Optimal Savings & Results

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.

Plan Overview
Plan Management
Plan Audits
Plan RFP
Pharmacy Plan Overview & Performance Report

Does your plan measure up?

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:

  • Evaluating your Pharmacy Benefit Manager (PBM)/Carrier Pharmacy contract and comparing it to the marketplace
  • ‍Assessing your plan design and how it impacts member behavior
  • ‍Gauging utilization of high-cost drugs, specialty and compounds
  • Evaluating key metrics such as plan cost Per Member Per Month (PMPM), generic fill percentage and mail utilization percentage
  • Comparing key metrics to benchmarks that match the incurred date of data or reports received
  • Evaluating and/or creating a strategy for meeting your plan’s financial and clinical objectives

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:

  • Executive Summary
  • Cost Trends
  • Demographics – Claimants
  • Demographics – Plan Cost
  • Top 10 Drugs
  • Top 10 Therapy Groups
  • Top 10 Pharmacies
  • High Cost Claimants
  • Specialty Drugs
  • Specialty Top 10
  • Ingredient Cost Breakout and Trends
  • Glossary

To learn more about our consulting services, click the button below to download a copy of our brochure.

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ON-GOING Pharmacy Plan Management

Rx evolves, your plan should too

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:

  • Review and renegotiate any contract terms that might be minimizing discount performance
  • Developing a strategic plan and custom solutions to meet plan goals
  • Providing monthly, quarterly, and annual data analysis and reporting to identify trends, cost drivers, high-cost claimants and solutions to continue meeting goals
  • Presentation of reports at quarterly and annual meetings
  • Comparing your plan’s key metrics to benchmarks
  • Developing a plan to manage specialty drugs
  • Developing monthly and annual plan design report that identifies claims not processed according to plan specifications‍

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:

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Is your PBM performing?

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:

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It's time to find your perfect PBM

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:

  • Developing a Project Charter detailing the objectives of the job, including completion. Charter includes Project description, deliverables and timelines, objectives and resource requirements
  • ‍Development of the questionnaire to go to all bidders and providing each bidder with plan data for claims reprice
  • Evaluation of questionnaire and claims reprice when returned from bidders
  • ‍Organization of a results document that includes findings and recommendations
  • ‍Coordination of presentations from finalist potential vendors
  • ‍Creation of timeline and facilitation of implementation once bidder is selected
  • Negotiation of contract

Learn more about our customized reporting with CobaltRx Connect

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