RxAdvocate December, 2024 — Newsletter

December 12 RxAdvocate December, 2024 — Newsletter

RxConnection FAQs

Will RxConnection reach out to employees directly to address pharmacy benefit related questions or issues?

Our Role is to provide direct support to our broker partners and clients, but this does not include direct employee contact. A few reasons for this include the following:

• Our account teams do not have the same availability as the customer care center. Many Pharmacy Benefit Manager customer care centers offer support 7 days a week, whereas our account team is limited to regular business hours.
• Our account teams do not have a recorded telephone line in case there are any member discrepancies, and a call would need to be pulled and reviewed.
• As a consultant, we do not have access to the same systems or level of detailed information as a Pharmacy Benefit Manager would regarding a claim or reject.

For the reasons above, we ask that employees be directed back to the Pharmacy Benefit Manager customer care team to assist them in the best manner. Employees do have direct access to contact their PBM customer care centers at any time.

What are a few ways that RxConnection can support management of pharmacy benefits?

• Customized Strategic Planning
• Data Analysis & Insights
• Training & Educational Resources
• Support for Client & Member Issues
• Renewal & RFP Oversight
• Implementation Support & Disruption Management
• Clinical Resource for Decision Support
• Ongoing Review of Emerging Trends and Wasteful Spend
• Consultation on Benefit Design
• Plan Performance Review & Strategy
• Review of PBM Programs

Although we do not provide direct member communication, as your pharmacy benefits consultant, we are always here as another layer of support and are here to assist with any pharmacy benefit questions you may have.

Pharmacy benefit management takes a village and RxConnection is here as a layer of support through your pharmacy needs. For clients, we aim to serve as an extension of your HR team to provide decision support. For brokers, we provide pharmacy benefit expertise including access to a pharmacist at your fingertips. By utilizing our Total Risk Management (TRM) services, you have a team of advocates to help review and manage your pharmacy plan across three areas (financial, clinical, and service) that can impact costs and members the most.

Change is never easy and making the decision to move to a new vendor can seem overwhelming. We are here to support you every step of the way through a new Pharmacy Benefit Manager transition. Here are a few of the ways we support the implementation process:

• Implementation calls: This will vary by PBM; however, you can expect to have at least 2-3 calls to walk through the PBM’s benefit design documents. Calls will generally start 90 days before the targeted implementation date, depending on your PBM vendor. RxConnection will attend each implementation call scheduled and provide any guidance and/or recommendations based on the latest industry insights.

• Member Disruption Analysis: Each PBM formulary can be different. As a result, there will always be some disruption when moving to a new vendor. The PBM will provide an analysis for your review on the number of members impacted by the formulary transition. Your RxConnection team will review the member disruption analysis to provide guidance and ensure a smooth transition for all members.

• Member Communications: Members must be notified of the transition to a new PBM and made aware of changes to their prescription benefit in a timely manner. Communications will need to be sent that require your review and/or approval. RxConnection can help by creating or reviewing content and collaborating with you to ensure the communications are sent to members on the targeted timelines.

• Review and Final Approval of Implementation Documents: Implementation documents can be lengthy and complex, and PBMs will require a final sign-off before coding your prescription benefits. Your RxConnection team will provide a second set of eyes to review these documents, and request testing of the benefit configuration to ensure accuracy.

• Post Implementation Review: Once the plan has reached the go live date, the PBM will monitor claims activity and provide updates. RxConnection will monitor all post go-live claims to ensure rejections are appropriate and claims are paying for the correct copays.

Please reach out to your dedicated Strategic Account Executive for any questions regarding your implementation process and our services.

BenefitsAlly 3x3x3 Challenge

On December 9th, Zach Jones, a part of our RxConnection Sales Team took part in the 3x3x3 Challenge with Chris Fisher, founder of BenefitsAlly. The 3x3x3 Challenge is a brief video where industry partners answer three questions, with three slides, all within 3 minutes. The intent is for viewers to learn what a company does, how they differ from one another, and determining who is deemed a good fit.

The 3x3x3 Challenge is geared towards Benefits Professionals in that they can contact these vendors directly to set up time to discuss these solutions further. Hundreds of 3x3x3 Challenges have taken place to date. RxConnection is focused on educating clients on how to achieve savings, reduce waste, and provide a more sustainable pharmacy benefit for employers and their members.

Movement for a Better World

One of our Strategic Account Executives, Joey Nuez, and her family participated in “Movement for a Better World” through their church to support families in need during the holiday season. In November, Joey and her family delivered Thanksgiving dinner, all the fixings and supplies for a family in need. They were able share their kindness and create a new bond with a grandmother and her grandchildren. Joey and her family will also bring additional supplies such as food, sheets, blankets, and medical supplies to the same family for Christmas.

This family’s holiday wish was to have company and conversation, and that is what Joey, and her family were able to provide them. Joey states “This family was so appreciative, and we look forward to seeing them again. It really was a blessing for all of us!”

Happy Holidays & New Year

Wishing you a Happy Holiday season from the RxConnection team!

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