Frequently Asked Questions

Will it be hard to implement?
Do I have the right people or processes to run a PBM?

FRx delivers a fully functional PBM on day one for you to own and/or operate.  The solution provides the people, processes, and technology necessary for successfully owning and operating your own PBM.  You choose to transfer day-to-day operations from us at the outset, or you can take control one process/operation at a time. The best part is that you own your PBM, so you can reclaim control.  PBM in a Box includes the technology platform, people, and processes that make it work.

We don’t have experience with managing risk.

FRx is backed by highly qualified professionals who understand the nuances and the complexities of government-sponsored and commercial programs across all lines of business.  FRx provides management of network and pricing, monitors performance objectives, and ensures reconciliation between actual performance and contract rates to minimize risk and get optimum pricing.  Along with managing retail pharmacy contract compliance, we will develop and maintain retail and mail-order MACs.  Additionally, we will manage the pharmacy credentialing and enrollment to reduce the risk.

I don’t have the technology, knowledge, or an IT team.

FutureRx provides a cloud-based, modular, business user configurable technology platform that is 100% compliant with government-sponsored regulations out of the box.  The modules allow business users to implement and configure all aspects without IT or support help.

 

Current antiquated PBM systems (~90% of claims are being adjudicated on systems that were built at least 30 years ago) and processes are plagued by numerous shortcomings, beginning with a failure to understand the complex and continuously evolving compliance requirements in today’s Medicare and Medicaid environment—placing plans at risk of penalties in the range of hundreds of thousands of dollars per audit.

Why? Because current systems and processes lack the prerequisite flexibility and expertise to ensure compliance.

FutureRx is an industry-leading PBM technology platform backed by highly qualified industry professionals who understand the nuances and the complexities of pharmacy benefit administration across government-sponsored programs and other lines of business.  The FRx Platform was intentionally built from the ground up to meet complex and continuously evolving compliance requirements in today’s Medicare and Medicaid environment—avoiding placing plans at risk of penalties in the range of hundreds of thousands of dollars. As a result, FutureRx delivers comprehensive solutions to all your PBM problems and is 100% compliant out of the box with all Medicare and Medicaid rules and regulations.

We don’t know how to build or manage network contracts.

We have a network you can leverage, we can build and administer a network specifically for you, and/or we can administer your existing network.

 

Our prebuilt network has 66,000 pharmacy rebate contracts. It is pass-through and negotiated by FutureRx.  We partnered with leading drug aggregators to offer the best pricing and rebates in the marketplace. The beauty of this model is that we are stronger together–as we grow members on the FutureRx platform, we leverage the collective membership to improve rates and pass the additional savings to you.  It’s yours to use. 

 

As an alternative, FutureRx can administer plan contracting and rebates.  Each client may have different needs for pharmacy coverage.  FutureRx can customize and build your ideal network based on size, area, or financial and clinical goals.  We can administer, maintain and monitor these custom networks for you.

 

One of the other innovations is our Best Price Model.  You can leverage any network in the FutureRx ecosystem and, while we are adjudicating the claim, we will utilize an innovative “best price” approach where we scan network contracts to find the best price available for any drug, either at point of sale or by pushing mobile notifications to the member for optimal fulfillment. 

 

Also, you control the right to configure, monitor, and fully audit the network and rebates.

I am concerned about compliance and audit.

FutureRx’s platform and processes are 100% compliant out of the box with Medicare and Medicaid rules and regulations.  Our seasoned compliance and subject matter experts support you on audit, compliance, and other regulatory issues.  Staying compliant can be a large task that takes focus off your growth.  FutureRx continuously monitors and adheres to all regulations, alleviating the unknown and providing protection from the complexity of government regulations.

I am concerned about my Star ratings.

Part D performance stopped MA-PDs from reaching 4 Star or above status and can impact up to 50% of the plans overall rating.  Nearly half of MA-PD plans still struggle with quality achievement and are falling short of the 4.0 rating necessary to earn the 5% bonus payment.  Nationally, this amounts to an average of nearly $42 per member per month.  Additionally, plans with a 3.5 score and above get to keep a higher portion of overall revenue for delivering better benefits.

 

Part D criteria in the ratings are tied to how the pharmacy performs.  FutureRx’s platform focuses on managing chronic conditions, medication safety, and MTM in order to raise and maintain your score.  Our proactive solutions are built around adherence, analyzing data, formulary strategies tied to Star ratings, and regulatory changes so you can provide marketing and enrollment advantages over lower rated plans.  One of those solutions is pay-for-performance.  For pharmacies, it’s all about accessing new patients and providing care through clinical services.  FutureRx pay-for-performance models provides an opportunity to create new ways of delivering and paying for care by allow pharmacies to earn bonus payments.  Our platform is prepared for value-based care and a focus on demonstrating the impact they have on patient outcomes and reducing total cost of care.

I don’t know how to manage my specialty drug cost.

FutureRx’s platform has built-in utilization management tools to efficiently manage spend.  Prior authorization rules, step therapy, and quantity limits ensure the appropriate use of medications and manage total drug spending.  Adherence management programs offer additional tools to change member behaviors.  These programs focus on therapeutic outcomes by monitoring a member’s drug therapy and providing counseling if necessary.  Interactions with the member can be done by text, email, or phone. 

 

Managing specialty costs can seem complicated, however FutureRx is addressing the high costs associated with specialty drugs through strategies that ensure proper spending.