1. Experience nationwide since 1986
  2. URAC certified since 1997
  3. 99.9% on-time for anywhere from 2-7 business days
PBM Services Overview
The primary responsibility of a PBM (pharmacy benefit management) company is to process and pay for prescription drug claims, negotiate discounts and rebates, implement and maintain formularies and establishing a network of pharmacies for cost control. Since Utilization Management is in our DNA, our additional focus is on the most appropriate use of pain management for insured workers. Not only is this best for the patient's health, but also typically is less expensive in the long term. In our perspective, it is better to focus on management of the overall medication regimen than per pill costs - the cheapest pill is the one not bought.
Some of the unique values that PRIUM provides as a PBM are:
Online - Real-time management of eligibility data
Reporting - Real-time access to data and reports
Network depth - Over 64,000 pharmacies nationwide and tools to optimize in-network use
Customer service - Proactive and responsive service, including 24x7 Call Center for pharmacies and a dedicated account manager
Plan Design - Upfront plan design for customizable management of the process
Limited formulary - Standard or customized decision tree for how drugs (from class to NDC) are processed by the Pharmacy POS
Controls - Restrict days supply, doses per day, physicians that can prescribe, pharmacies that can fill
Exception handling - Management of prior authorization and reject transactions
Price competitive - Generic enforcement, mail order, high value returned for the price
Focused - Strategic and tactical focus on Workers' Compensation
Integrated Utilization Review - Monitoring opportunities for pain management optimization
Clinical oversight - Physicians (nationwide, multi-discipline, active-practice) involved in the UR process
Actionable sentinel - Proactive identification of outlier claims (by trends and Evidence Based Medicine) to create management action plans
TEC – Embedded Therapeutic Equivalent Conversion program
POPProvider Outreach Program, proactive TEC
Quality - PRIUM has been accredited by URAC since 1997
Consulting - Jurisdictional, claims processing, clinical and pharmaceutical consultative services
Implementation - Support of cutover to reduce transition noise and effort required
Jurisdictional optimization - Compliance with and leverage of each jurisdiction's unique requirements
Turnkey - As much or as little administrative support that is needed to offload time and cost