Every company needs to provide their employees enough health coverage as stated by the law. This includes medical assistance, leaves, even provision of pharmaceutical drugs and treatments. Apart from the high inflation of medical service cost, medicines follow as a major expense. This strengthens the necessity of including medicines in the health coverage.

1. Ensuring your Clients Get the
Most of Their Pharmacy
Benefit Program
Crystal Clear RX
19753 East Pikes Peak Avenue,
Suite G-103, Parker, CO 80138
(303) 955-7827

2. Every company needs to provide their employees enough health coverage as stated by the
law. This includes medical assistance, leaves, even provision of pharmaceutical drugs and
treatments. Apart from the high inflation of medical service cost, medicines follow as a
major expense. This strengthens the necessity of including medicines in the health
coverage.
This need entails a large amount of money companies have to spend on their employees’
health coverage. Brokers and consultants tend to look for a suitable pharmacy benefit
manager for their clients that is worth their money. Most of all, they will look for PBMs that
will be able to take care of their clients’ employees.
Most PBMs have competitive employees to ensure a good service. Unfortunately, even
state-of-the-art systems may fail. This may lead to errors and discrepancies that may
frustrate the clients. During these events, the brokers take the brunt of the clients’
discontent.
There are many ways to avoid this scenario, such as the following:
PBM Auditing
The broker needs to make sure that the
PBM is fulfilling the requirements of the
clients. The PBM should disclose the
information on the claims they
processed form the clients’ employees.
They should be able to uphold their
obligation in their contract.
While most companies do not audit the
PBM, the broker can do it on their
behalf. This may also help the company
distinguish the PBM worth
recommending for other clients.

3. PBM Selection and Contract Consulting
As the intermediary of the PBM and the
company, the broker should carefully select
and review the proposal of the provider.
They should be able to review the contents
and look into the provider’s background and
reputation to fulfil their side of the contract.
PBM Monitoring
Even after the contract, the broker should
observe the transaction from both the
clients’ side and the PBM’s side. There are
types of software that enable brokers to
check these types of operations. This will
enable them to take further action and
provide sound advice for their clients.
The job of an intermediary is a difficult
role to maintain especially in a large
industry such as healthcare provision. To
be able to make reliable judgment and
counsel to the clients, the broker must
carefully audit, select, and monitor the
PBM they are suggesting.

4. Sources:
http://crystalclearrx.com/content/pbm-services-consultants
http://crystalclearrx.com/content/should-i-audit-my-pbm-0
http://www.dol.gov/compliance/guide/