Pharmacy Benefits Administration has become complicated. We’re here to organize.

CareUS has you covered

Consulting

In an ever evolving market, we’re here to help you navigate through the complexities. Whether it’s leading an RFP or guiding your specialty drug strategy, our consulting team is here for you

Audits

Establishing the right contract is paramount. Enforcing that contract is mission critical. Our audit team makes sure what was sold is what is delivered

CareUS Pharmacy Consulting

  • Without the right contract in place, you'll always be behind the eight-ball. Our team ensures you identify the right partner on the right terms and validates your PBM pricing continues to be best-in-class

  • In a constantly evolving world, shinning a light into what is coming, plus identifying opportunities through data. Our team is here to make sure there are no surprises

  • Specialty drugs can accomplish tremendous outcomes, but they are also responsible for driving trend. Our team is here to help you optimize your strategy, whether it's medical channel management or establishing a value based contract--we've done it and can help you do it

  • Led by our clinicians and analysts, we help you decide which treatments to authorize. We also have the in-house capabilities to support Level 1, 2, or 3 reviews to validate the right treatment is deployed at the right time in the right setting

PBM Audit

  • Rx Pricing

    We ensure the PBM meets the pricing guarantees specified in your contract for the audit period, evaluating claims data against your contract. We’ll work with the PBM to correct and reimburse any discrepancies.

  • Manufacturer Rebate

    Once a hidden revenue driver for PBMs, we audit the timeliness and accuracy of Rx Rebate payments made (or not made) by the PBM based on claims utilization.

  • Performance Guarantees

    We hold your PBM accountable to standards of operation. Our audit begins at the point of negotiation, ensuring clarity in both intent and reporting approach. We validate you get the product you purchased.

  • Utilization Management

    Prior Authorization is designed to protect your members from unproven treatments and you from unnecessary costs; the application often falls short of the expectation. We evaluate the PBM’s UM program to ensure accuracy and efficiency.

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