PayerAlly partners with our clients to develop customized work plans that provide comprehensive support to better manage their pharmacy programs. The services we provide include:
- Pharmacy Benefit Management
- Specialty Pharmacy
- Rebate Management
- Medical Drug Management
- Medication Therapy Management (MTM)
PayerAlly will allocate a financial analyst and dedicated PharmD to support each procurement project to help your firm develop pharmaceutical strategies that will better manage overall prescription drug costs. At PayerAlly, we believe that managing a successful vendor procurement requires a dedicated team that can focus on all the appropriate elements that make up a successful agreement, including financial, clinical, and operations. We always allocate the right resources, timeframe, and project management expertise to help our clients have a best-in-class vendor agreement.
PBM Monitor Program
The PayerAlly PBM Monitor program is designed to give our clients the appropriate vendor oversight while maximizing the value of their PBM vendor relationship. This program includes clinical support, ongoing industry information related to new medications, and cost-saving strategies, including Specialty medications. The monitor program is a combination of quarterly financial monitoring, clinical analysis, and operational support to track the performance of the PBM vendor to the contract terms to ensure that the vendor is proactively meeting all contractual commitments.
- Financial Audits
- Rebate Audits
- Benefit Design Audits
- Clinical Rule Audits
- Coverage Determination Audits
PayerAlly has a full suite of audit services designed to support the unique needs of all our clients including annual financial audits, onsite rebate audits, benefit design audits, and clinical rule audits for clients that have custom clinical programs in place with their PBM vendor. PayerAlly does not operate a PBM coalition. Clients can rest assured that an unbiased expert is conducting the audit without needing access to confidential cost of goods or exposing competitive intelligence via an audit process managed by a potential competitor.
PBM & Specialty Pharmacy Benchmarking
PayerAlly provides financial benchmarking for data-driven market PBM market checks and provides health plan clients with the ability to compare their current performance to the broader industry. PBM benchmarking includes network discounts, rebate yields, administrative fees, and ancillary fees, and can be broken down into detailed elements (i.e. total cost per day per therapeutic category).
Strategic Pharmacy Consulting
PayerAlly provides Strategic Pharmacy Consulting expertise to payers looking to improve the competitiveness of their pharmacy operations. The services include assessments of pharmacy staff, PBM consulting and training, underwriting support, supplemental staffing, and value proposition development.
Clinical Program Development and Oversight
PayerAlly has clinical resources to help clients build and evaluate clinical programs and other pharmaceutical utilization management strategies to be proactive in drug cost management. Our resources can also evaluate ongoing program effectiveness to ensure they meet your business needs in an ever-changing environment.
PayerAlly has research associates who can develop custom market research for our clients covering the areas of drug pipeline, reimbursement channel (medical or pharmacy benefit), patient assistance programs, competitive analysis, industry legislation, and other ad-hoc pharmaceutical industry topics.
PBM Implementation Management Services
If clients decide to transition to a new vendor for PBM services, PayerAlly has an implementation team to support the transition, including project management, benefits testing and coding, and pre and post-implementation support.