Contain costs and engage members with PCM.
With PCM you can manage all value-added Rx and medical solutions in one place. Implement a program with our trusted partners or integrate your own programs. Our management platform is built to customize, fitting your needs.
Why contain costs and engage with PCM?
Managing third-party vendors is time-consuming for one plan, let alone your entire BOB. With PCM’s interactive platform, all program data is aggregated for faster, more efficient vendor management.
Support Solutions
- PCM Rx Savings
- Rx Cost Containment
- Clinical Review
- Medical Cash Payment
PCM Rx Savings
PCM Rx Savings is the original pharmacy savings program. By engaging physicians to switch participants from high-cost drugs to lower cost alternatives, PCM provides self-insured plan sponsors an average of 8-10% savings on total spend.
- Proactive participant engagement
- Validated PMPM savings
- Full-suite program reporting
- Dedicated Rx Engagement Team
The Rx Savings Process
PCM does the work. You see measurable, long-term cost containment for your plan or your client.
Identify low-cost Rx alternatives.
Our proprietary system analyzes claims and eligibility files to identify high-cost drugs and lower cost Rx alternatives.
Engage physicians.
PCM’s certified and licensed pharmacy team, contacts member’s doctors with cost-savings information.
Gain member approval.
A member of our Rx Engagement Team reaches out to plan members for approval on proposed alternatives.
Facilitate Rx fill.
PCM pushes approved alternatives to the member’s pharmacy for quick, seamless fill that doesn’t interrupt the treatment plan.
PCM Rx Engagement Team
Our team of in-house licensed pharmacists and certified pharmacy techs make navigating pharmacy care simple for plan members:
- Proactive outreach on savings opportunities.
- Personalized pharmacy education for members and providers.
- Expert guidance for improved clinical outcomes.
- Focus on lower out-of-pocket costs AND member health.
Validated Plan Savings
PCM Rx Savings is not like other cost containment programs. We provide line-by-line, drug-by-drug validated savings, so you can see where plan dollars are going. And the process is easy:
- No plan changes required
- Quick implementation
- Limited HR workload
- Minimal participant disruption
- Lower patient copays
See where your money is going with a complimentary analysis.
Cost Containment
Engage members and providers to act on high-cost drugs. Our dedicated support team is here to do the heavy lifting, and our automated system is flexible enough to implement your vendors, a la carte.
- Flexible Implementation
- Comprehensive Reporting
- Measurable PMPM Savings
- Interactive Management Platform
- Consolidated Claims
Value-Added Cost Containment
Select the programs that fit your benefit strategy or integrate your vendor in our system.
Alternate Funding
- No plan changes
- $0 participant co-pay
- High case approval rates
- Lower specialty spend
International Rx
- No medication changes
- Direct shipping
- Auto Rx identification
- Minimal disruption
Rx Tourism
- 5-star facilities
- Full-service concierge
- Locked-in rates
- Up to 70% savings
Simplified Solutions
PCM’s bolt-on cost containment solutions support brokers, consultants, TPAs, self-insured plans, and PBMs in building sustainable benefits packages that promote plan growth and participant engagement.
With flexible implementation and comprehensive reporting, our team does the heavy lifting, you see the results.
Build a plan-specific cost containment program with PCM.
Clinical Review
PCM’s clinical review solutions focus on balancing clinical outcomes and costs to prioritize member health. Specialty Review and Precision PGx support benefit experts in managing complex conditions with:
- Patient-focused care
- Reduced medical costs
- Improved patient outcomes
- Higher member engagement
Model-Based Care with Specialty Rx Review
Utilizing real-world evidence, Specialty Rx Review is a model-based care management solution that drives personalized specialty treatment. This, in turn, provides your participants with:
- Individualized Care Planning: Specialty plans tailored to meet participant needs.
- Hassle-Free Implementation: Easy, anytime implementation with limited participant disruption.
With Specialty Rx Review, plan can manage financial costs and improve health outcomes one person at a time.
Personalized Treatment with Precision PGx
Based on drug-gene interaction, Precision PGx identifies a participant’s metabolic rate which encourages doctors and patients to make informed decisions, resulting in reduced medical costs, improved participant health, and enhanced drug efficacy.
The PGx process is simple.
PCM identifies members who may benefit from PGx testing, then members receive a simple oral swab to complete at home.
Tests are processed and the results sent directly to the member using secure HIPAA guidelines.
Members can discuss results with a doctor via telemedicine or with their primary care provider.
Improve Health and Reduce Healthcare Costs
Our clinical engagement programs target the health and well-being of plan members, with additional administrative and reporting support from PCM’s clinical experts.
- Lower Health Care Costs: Manage and prevent chronic conditions, containing medical treatments and hospitalizations.
- Improved Utilization: Encourage preventative services for more fewer hospitalizations and more favorable chronic treatment.
- Health Data Insights: Collect and analyze health data, providing valuable, tailored insights to meet member needs.
- Broker Collaboration: Add value by connecting self-insured plans with vendors, creating a more comprehensive package.
- Attract and Retain: Use robust clinical program offerings to provide plan strategies that attract and retain customers.
Improve clinical outcomes and participant health with PCM.
Medical Payment
Claim review, data transparency, and cash-pay models provide measurable cost-savings while helping members choose smarter healthcare.
- Medical Specialty Management
- Payment Integrity
- Cash Pay
Medical Specialty Management
With Medical Specialty Management, the plan gets visibility into how markups on medical pharmacy are affecting plan spend.
- Multi-vendor integration
- Secure storage and transmission
- Single point of access
- Standardized semantics
- Historical data storage
Payment Integrity
Review claims before and after payment to identify improperly billed, processed, and paid claims, savings the plan and its members 5-25% of their healthcare spend. With payment integrity plans can prevent and recover improper payments today.
- Pre-payment review to ensure accuracy
- Post-payment identifies overpayments
- Asset recovery
- Standardized semantics
- Historical data storage
Cash Pay
A direct, transparent, immediate cash-pay model for plan sponsors. An efficient payment method.
- Multi-vendor integration
- Secure storage and transmission
- Single point of access
- Standardized semantics
- Historical data storage
Take medical into account with PCM.
Contain costs and engage members with PCM.
With PCM you can manage all value-added Rx and medical solutions in one place. Implement a program with our trusted partners or integrate your own programs. Our management platform is built to customize, fitting your needs.
Why contain costs and engage with PCM?
Managing third-party vendors is time-consuming for one plan, let alone your entire BOB. With PCM’s interactive platform, all program data is aggregated for faster, more efficient vendor management.
Support Solutions
- PCM Rx Savings
- Rx Cost Containment
- Clinical Review
- Medical Cash Payment
PCM Rx Savings
PCM Rx Savings is the original pharmacy savings program. By engaging physicians to switch participants from high-cost drugs to lower cost alternatives, PCM provides self-insured plan sponsors an average of 8-10% savings on total spend.
- Proactive participant engagement
- Validated PMPM savings
- Full-suite program reporting
- Dedicated Rx Engagement Team
The Rx Savings Process
PCM does the work. You see measurable, long-term cost containment for your plan or your client.
PCM Rx Engagement Team
Our team of in-house licensed pharmacists and certified pharmacy techs make navigating pharmacy care simple for plan members:
- Proactive outreach on savings opportunities.
- Personalized pharmacy education for members and providers.
- Expert guidance for improved clinical outcomes.
- Focus on lower out-of-pocket costs AND member health.
WHY PCM
Validated savings.
PCM Rx Savings is not like other cost containment programs. We provide line-by-live, drug-by-drug validated savings, so you can see where plan dollars are going. No plan changes required, quick implementation, and minimal disruption to HR or plan members.
Cost Containment
Our suite of cost containment solutions engage members and providers to act on high-cost drugs. Our dedicated support team is here to do the heavy lifting, and our automated system is flexible enough to implement your vendors, a la carte.
- Turnkey implementation
- Comprehensive reporting
- Measurable PMPM savings
- Interactive management platform
- Consolidated claims
Value-Added Solutions
Select the programs that fit your benefit strategy or integrate your vendor in our system.
WHY PCM
Simplified solutions.
PCM’s bolt-on cost containment solutions support brokers, consultants, TPAs, self-insured plans, and PBMs in building sustainable benefits packages that promote sustainability and engagement.
With flexible implementation and comprehensive reporting, out team does the heavy lifting, you see the results.
Clinical Review
PCM’s clinical review solutions focus on balancing clinical outcomes and costs to prioritize member health. Specialty Review and Precision PGx support benefit experts in managing complex conditions with:
- Patient-focused care
- Reduced medical costs
- Improved patient outcomes
- Higher member engagement
SPECIALTY RX REVIEW
Model-Based Care
Utilizing real-world evidence, Specialty Rx Review is a model-based care management solution that drives personalized specialty treatment. This, in turn, provides your participants with:
Individualized Care Planning
Specialty plans tailored to meet participant needs.
Hassle-Free Implementation
Easy, anytime implementation with limited participant disruption.
With Specialty Rx Review, plan can manage financial costs and improve health outcomes one person at a time.
PRESCISION PGX
Personalized Treatment
Based on drug-gene interaction, Precision PGx identifies a participant’s metabolic rate which encourages doctors and patients to make informed decisions, resulting in reduced medical costs, improved participant health, and enhanced drug efficacy.
The PGx process is simple.
WHY PCM
Improve health. Reduce costs.
Our clinical engagement programs target the health and well-being of plan members, with additional administrative and reporting support from PCM’s clinical experts.
- Improved utilization
- Health data insights
- Broker collaboration
- Strategic management
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