PBM Compliance
Galen DSS provides GER reports of generic to brand drugs that assist Independent Community Pharmacies and Medical Facilities with information that reduces Claw Backs and DIRs.
PBMS and REBATES
- Pharmacy Benefits Managers (PBM) coordinate drug acquisitions between Community Pharmacies, Medical/Veterinary Facilities and Distributors
- Rebates are provided by distributors to the Community Pharmacies or Medical Facilities that purchase a specified quantity of a drug
- This is the estimated “Threshold”
- PBMs obtain the rebate and pass along to the Community Pharmacy or Medical Facility
HOW DO WE
ENSURE COMPLIANCE?
- Rebate Report:
- Client file is accessed to identify current cost of the drug
- Distributors and their prices are identified
- Generic Effective Rate, (GER) is used by a PBM to calculate a rebate allocated to the Community Pharmacy or Medical/Veterinary Facility
- Using the GER, client report and the PBM rebate, the cost of the drug, after the rebate is established, is the Community Pharmacy or Medical/Veterinary Facility cost
- Galen GER and Ratio Reports
- The GER Report is calculated periodically to ensure that ratios of generic to brand drugs are near the PBM specification. If the calculated GER and drug ratios are kept close to specifications, rebates will be retained, and claw backs will be minimized.
Results using Galen DSS
- Rebate calculations are made available to a Community Pharmacy and Medical/Veterinary Facility: Pricing becomes transparent
- Productive negotiations are available to the Community Pharmacy or Medical/Veterinary Facility
Features and Functions
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