Since 2016, a local union group with 2,500 members has been working with PillarRx. As the group’s member needs diversified, the client believed the PBM contract needed improvement.
PillarRx reviewed the contract and performed pharmacy claim audits for the previous 2 years. These retrospective pricing audits validated that the PBM was performing up to contractual obligations. However, several areas of improvement were noted in the contract. PillarRx worked on behalf of the client to increase performance guarantee thresholds and improve upon more competitive pharmacy rates.
The PBM made the contractual changes and PillarRx was retained to ensure pharmacy claims and financial agreements were properly aligned with the new PBM contract. Through PillarRx’s ongoing PBM monitoring services, PBM errors totaling over $650,000 were uncovered due to contract non-adherence. PillarRx worked with the PBM, ensuring these errors and potential pharmacy claim mis-adjudication will not occur going forward. We continue to perform annual pricing audits and quarterly PBM monitoring.