WHAT’S NEW IN THIS RELEASE
Feature
- Ability to Change the Financial Summary Date Range
- Addition of Consulting & Technology Fees to the Financial Comparison
- Ability to Calculate PEPM or PMPM Admin Fees
- Updated RFP Questionnaire
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Ability to Change the Financial Summary Date Range
After selecting “Edit Financial Summary” from the action menu you will be given a modal to select the date range to be selected. The bar graphs represent the number of claims in each month. This is done for two reasons. First, if consultants have imported claims data that is greater than 12 months, or has only a few claims in a given month – the consultant can exclude those claims in their analysis by not selecting them. The second reason was to give a baseline for PMPM and PEPM fees to be calculated.
Addition Consulting & Technology Fees to the Financial Comparison
Consulting and Technology fees will be added as a row in the financial calculation. If a PBM selects “Built into discount guarantees” or “Included in transaction fee” the line item will read “Included”. If a PBM selects “billed separately to client” the line item will show the calculated fee totals.
Ability to Calculate PEPM or PMPM Admin Fees
The updated release will support PBM’s that charge admin fees on a PEPM or PMPM basis instead of only a Per Claim basis.
Updated RFP Questionnaire
Along with minor changes to the wording of existing questions. The below questions have been added or altered in a way that affects their meaning.
Guarantee and Reconciliation Logic
8. AWP is based on Medi-span and the date of fill
19. Rebate guarantee reconciliation will not include any rebate credits for shifts in utilization (biosimilars, insulins, etc.)
Adjudication Logic
6. Specialty medications that do not clinically require a days supply greater than 30 will receive a specialty rebate guarantee based on a per 30 day supply.
Termination Clauses
2. No early termination penalties will apply
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