PBMs handle prescription drug benefits on behalf of health insurers, Medicare Part D prescription drug plans, major employers, and other payers. By negotiating with drug manufacturers and pharmacies to control drug spending, PBMs have a significant behind-the-scenes influence in determining total drug costs for insurers, shaping patients’ access to medications, and determining how much pharmacies are paid. PBMs have been subject to increasing scrutiny regarding their role in rising prescription drug costs and spending.
PBMs are contracted by health plans, major businesses, unions, and government agencies to administer prescription medication coverage programs. In the 1960s, they were developed to process claims for insurance companies. In the 1970s, PBMs served as financial mediators adjudicating claims for prescription drugs. Today, PBMs not only adjudicate claims but also construct and administer pharmacy networks, determine prescription formularies, set co-pays, and establish criteria for prior authorizations and the patient’s pharmacy selection.
Originally intended to process claims on behalf of clients within a predetermined fee structure, they are often referred to as “invisible middlemen” because they are hidden between the patient’s insurance company, for whom the PBM works, and the pharmacy, which the PBM reimburses for filling the prescription.
SpectrumPS is exclusively dedicated to the hospice industry for a variety of reasons. We view this business as one that requires the assistance of a committed and all-encompassing partner who can take care of their particular prescription needs and make drug access for their patients simple when required. You will engage with your patients deeper than ever before and guarantee that they remain comfortable, cared for, and at peace by utilizing our pharmaceutical solutions and our network of carefully selected pharmacies that are experts in the Hospice industry.
SpectrumPS has worked diligently to establish a network of pharmacies near your patients. And when it comes to our network, an exhaustive screening process ensures that our exclusive selection of pharmacies equals the duty of serving our clients. When you partner with us, you have instant access to our hospice-specialized pharmacies that can process your requests more quickly, cater to the needs of hospice patients more effectively, and are located in your community, allowing you to provide better care for your patients. At the same time, you receive competitive pricing and clinical support to ensure the success of your surgery.
SpectrumPS is the best option for your hospice for various reasons, but we’ll let you discover them once we begin working together. In the interim, we will explain what we do, why, and how it will assist your hospice.
Our mission is to give each of our clients the pharmaceutical access they require at the lowest possible cost and with the utmost convenience to shift their focus from the pharmaceutical market to their quality of patient care. Keep your team up-to-date on current best practices through logistics and delivery, support, and instructional tools.
Pharmacists established our program just for pharmacists. We have the experience necessary to drive change in the industry, and we’re always seeking to provide tailored solutions that enable our clients to give more care than ever before.
How is PBM price determined?
On behalf of health insurers, Medicare Part D drug plans, major employers, and other payers, pharmacy benefit managers (PBMs) administer prescription medication benefits. By negotiating with drugmakers and pharmacies to cut medication spending, PBMs substantially affect insurers’ selection of overall drug prices, limiting patients’ access to prescriptions and regulating how much pharmacies can charge. Regarding their role in rising prescription drug costs and expenses, PBMs have been subjected to the strictest scrutiny.
How do pharmacy benefit managers affect the cost of prescription drugs?
PBMs serve as intermediaries in the distribution system for prescription drugs. Consequently, they:
Create and manage drug coverage lists or formularies on behalf of health insurers. Who determines the pharmaceuticals used by patients and the reimbursable expenditures?
Utilize your purchasing power to negotiate rebates and discounts with pharmaceutical producers
Spec trumps provides a comprehensive drug management program through its companies, including integrated pharmacy benefit administration, specialty pharmacy solutions, and prescription delivery services.
Its clients receive individualized pharmacy solutions integrated across medical and pharmaceutical benefit packages tailored to their community’s needs. As a provider of both PBM solutions and specialist drug management services, it may offer personalized, considerate drug management services to the individuals you serve.
What Does PBM Services Entail?
When using SpectrumPS as your pharmacy benefits manager, you can anticipate the following advantages:
- Integrated medication management strategies, including specialty pharmacy
- The most advanced technologies, reporting, and analytics
- A protected online membership gateway
- Practical strategies for member outreach and education
- Novel clinical therapy
- Customized management of formularies
- Home delivery services for prescriptions
- Twenty-four hours a day, 365 days a year, certified pharmacy professionals staff a live customer service help desk.
What Makes SpectrumPS Pharmacy Benefit Management Services Distinct from Competitors?
SpectrumPS, a reputable provider of innovative pharmacy benefit management services, is committed to pharmacy benefit program compliance and quality while continuing to innovate in crucial areas. We continually assess ways to improve our specialty pharmacy services, Medicare Part D coverage, home delivery program, and account administration capacities to benefit our customers.
We believe in delivering PBM solutions that include advanced, comprehensive medication management services to enhance the value of our members’ health coverage, improve treatment quality, and save costs.