Pharmacy Program Management

Reporting, benchmarking, and analytics that enable payers to adjust approaches that will improve the effectiveness and affordability of the pharmacy benefit.

Pulse8’s one-of-a-kind pharmacy program management product, Formul8, is a solution of software, services, and advisory offerings to assist payers of the pharmacy benefit to more effectively manage their providers including: the pharmacy benefit manager (PBM), network pharmacies, pharmaceutical manufacturers, prescribers, and patients/insurance plan members. 

Key features that make Formul8 the ideal solution to support payers in the management of the pharmacy benefit include:​

  • Clarity and transparency regarding the pharmacy and medical pharmacy benefit spend
  • Development of financial and performance guarantees that align with the level at which they underwrite risk – line of business, account, group, etc.
  • Implementation of value-based agreements with their PBM, central fill specialty and mail order pharmacies, and retail networks 
  • The option to in-source clinical and quality programs, including Medication Therapy Management (MTM), improving Drug Utilization Reviews (iDUR), and medication adherence
  • Improvement in oversight of the PBM’s claims, coverage determinations, and customer service operations to strengthen compliance position

Formul8 has been designed to meet the needs of payers based on first-hand experience with the complex and often unpredictable world of Pharmacy Benefit Managers (PBMs). Challenges such as financial pressures and low transparency are causing payers to seek a partner who can present opportunities for evolving the relationship with their PBM.

Formul8 assists payers with both short- and long-term needs, including strategically-presented insights, to optimize the opportunities identified using industry standards and client hierarchies. Client, market, and industry data are then run through Pulse8’s unparalleled analytics engine to create benchmarks that will determine savings opportunities.

Payers will now be able to choose pre-configured or set user-defined financial guarantees, as well as value-based agreements, that incorporate cost, quality, and clinical attributes. Payers will now be able to more directly engage with prescribers, patients, and pharmacies to improve safety, cost, quality, and compliance.

With a continually evolving pharmacy management industry, Pulse8 is the only objective partner that can support a payer’s relationship with its PBM, pharmaceutical manufacturers, pharmacy networks, prescribers, and patients.

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