By launching a full - service Pharmacy Benefit Administrator (PBA), PMCS and EBRx addressed the growing concern in healthcare today, which has been reiterated in several articles published by major news sources such as The Wall Street Journal, that many PBMs are conducting unethical price maximization practices, such as AWP manipulation, rebate disguising and formulary steering.
The Cost Plus Pass - Through Program provides cost savings and ultimately gives the administrator and the health plan complete control over their pharmacy costs. Utilizing this program, the health plan is charged the actual ingredient cost for the drug dispensed to covered individuals, as well as the actual dispensing charges. In addition, all rebates are passed through to the health plan.
"Just as a Third Party Administrator (TPA) administers medical claims, we have created the first true Pharmacy Benefit Administrator (PBA) that administers Rx claims strictly on a fee basis" states Jay Ver Hulst, President of EBRx. "In order to rise above the recent problems that have surfaced for other PBMs, we created our fully-transparent model to offer a more effective and accountable approach to the PBM industry."
David P. Morgan, R. Ph., President of Morgan Healthcare Audits LLC states, "EBRx understands the fiduciary responsibility that ERISA places on the TPA. They understand that for prescription costs to be truly controlled, there cannot be hidden games or hidden costs built into the system. A fee per claim as well as Rebates, Incentives, and Pharmacy Spreads are passed through with full financial transparency and 100% auditability and accountability." He continues, "For over 30 years pharmacists have been voted the most trusted professional. Now we have a PBM that is bringing that kind of integrity to the Pharma Industry. After spending 15 years tracking, analyzing, reporting and litigating PBMs, I have finally found one that I can endorse without reservation...EBRx."
Todd Roberti, Senior Vice President of PMCS comments, "PMCS is the first and only company to advance fund Rx receivables. By advance funding Rx receivables in three to five days, using the same model with which we advance fund medical receivables, we will be able to make the entire system more efficient, which will save money for everyone in the long run. The pharmacy gets its money faster and the employer will pay less, which is the way the system should have been working all along."
About EBRx, Inc.
EBRx is a fully integrated, comprehensive Pharmacy Benefit Administrator (PBA) that offers the highest quality and convenience to its customers. Since 1985, EBRx has grown steadily by providing a long-term commitment to each of its customers. Claims are now processed nationally for third party administrators, insurance companies and self-funded employers. EBRx provides an exceptional managed care prescription drug program that can be private labeled to meet the individual needs of its customers. Their mission is to provide the highest quality product available in the most courteous, convenient, efficient and cost-effective manner. Their standard of performance is 100 percent quality and 100 percent satisfaction, 100 percent of the time.
About Morgan Healthcare Audits
Morgan Healthcare Audits, L. L. C., (MHA- formerly known as Morgan Enterprises) is a consulting company which provides Pharma Industry audits and related services to health plans, Third Party Administrators and agencies of Local, State, and Federal Government. MHA assists in recovering overpayments, managing health care costs and assists in criminal litigations. MHA began in 1992 and for the past 12 years, has created a name for itself through tenacious investigative work and analysis by assisting pharmacy chains, insurance companies, government agencies, Pharmacy Benefit Managers, law enforcement and investigative agencies. MHA has an enviable background in Pharmacy, Computer Systems, Claims Processing and Investigative techniques. Using this unparalleled experience coupled with the latest computer technology MHA has pioneered original methodologies and techniques to conduct audits of PBM's and Pharmacies. MHA gained invaluable and extensive experience in Evidence Gathering for Criminal and Civil Court proceedings, and MHA applies the same approach to all audit activities. This means that every audit and every finding will stand up in court.
Preferred Medical Claim Solutions (PMCS) is the proven "Leader in Claim Settlement," with the nation's first and only Advance Funded Provider (AFP) program. Clients of PMCS have access to a cost containment solution that seamlessly incorporates into their daily claim processing routine. Founded in 1998, PMCS established a Preferred Data Interchange (PDI) between Payors and Providers to facilitate the processing of medical claims that were deemed eligible, but were submitted by medical providers not associated with the Payors primary network. PMCS continues to be a progressive partner in the healthcare industry with its services proven to efficiently reduce paperwork, disputes and the time it takes to render payment for services. By automating and streamlining the claim settlement process, PMCS has enabled its business partners to save millions of dollars. To learn more about the solutions that PMCS offers, please visit www.pmcsaz.com.