The HighPoint Solutions Pharmacy Benefit Management (PBM) Practice drives organizational excellence through our deep working knowledge of information technology, comprehensive healthcare domain understanding, and life sciences industry expertise. Our combined experience in supporting health plans and the majority of the top 25 pharmaceutical manufacturers uniquely positions us as a high impact player in the PBM industry. Our goal is to assist plan sponsors in achieving operational excellence, while controlling administrative and drug spend costs.

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In today’s fiscal environment, pharmacy benefits are in high demand in order to contain costs. HighPoint’s team of specialized industry consultants is well positioned to assist organizations in meeting and exceeding strategic goals as they relate to pharmacy benefit programs. With a proven knowledge of the entire PBM lifecycle from enrollment/eligibility through claims processing and trends analysis, we support all areas. Our team understands the inter-relationships between the various components that are necessary to support a pharmacy benefit. The key to our approach is proactive data management, rather than relying on lagging indicators. Our team has proven expertise in the following areas:

• PBM Claims Management
• Medicare Part D Services
• PBM Rebate Management

HighPoint Solutions is in a position to effectively improve the management and oversight of PBM processing operations. Using analytics and business intelligence techniques, claims data can be analyzed – resulting in improved patient care and reduced drug spend. Key services available include:

• Audit and Pricing Support
• Claims Management and Analysis
• Claims Reconciliation
• Data Warehouse and Analytics Support
• Financial Management
• Formulary Management and Analysis
• Fraud and Abuse Detection
• Recognition of High-Risk Utilizers
• ROI and Effectiveness Analysis
• Monitoring and Analysis:
  • Beneficiaries
  • Established KPIs
  • Patterns and Trends
  • Pharmacies
  • Physicians
  • Prescription Drug Utilization
• Support of MTM Services

Our experienced team of consultants has been involved with the Part D program since its inception with The Medicare Modernization Act (MMA) of 2003. The MMA – the establishment of the Medicare Approved Discount Drug Card – and the Medicare Part D programs created significant operational challenges. HighPoint has experienced consultants to assist both PDPs and MA-PDs in achieving both tactical and strategic objectives. We offer a complete solution for your Medicare Part D and MA-PD needs, including the following key support elements:

• CMS Audit Preparation and Support
• COB Services
• Compliant Document Storage
• Discrepancy Resolution
• Electronic Funds Transfer
• Enrollment Processing
• Enrollment Reconciliation
• EOB Generation
• Financial / Claims Reconciliation
• Inbound Payment Services
• Integration with PBM
• Integration with Print Vendors
• Mail Processing and Tracking
• Outbound Correspondence
• PDE Reconciliation Services
• Pharmacy Payment Services
• TRR Applications and Resolution
• Workflow Solutions

HighPoint can also assist health plans and payers reduce total drug spend by efficiently managing rebate claims data and contracts with pharmaceutical manufacturers. We provide reporting and administrative services that maximize rebate benefits received from manufacturers. Support services include rebate calculations, invoicing, and reconciliation.

• All Phases of Rebate Payment, including Calculation and Submission
• Financial Reporting
• Formulary Management
• Manage and Administer Manufacturer Rebate Formulas
• NDC Maintenance
• Provide Rebate Administration Services to Payers
• ebate Contracts Management
• Rebate Data Analysis with potential Formulary Improvement Recommendations
• Reconciliation, Research, and Dispute Resolution