For a single fixed PMPM fee, you get all of the services from our transparent PBM:

A national network of 60,000 pharmacies including specialty and mail order

Real-time claims processing using our own processor

Prior Authorization (both ePA and Covermymeds)
Rulebased transparent step therapy

Flexible and dynamic formulary and plan design

Drug utilization management

Rebate management (your own aggregators or ours)

Payment processing (835 plus ACH)

Integration with TPA and other accumulators

Analytics
Role Based Access
& More

What should a PBM do?

Manage Pharmacy Benefits cost effectively

Provide timely access to clinicians and members securely

Define Benefit Plans with flexibility to modify in real time

What should a PBM not do?

  • Not get bogged down in technology

RxSpokes – Functions & Features

RxSpokes is a PBM Platform as a Service. The RxSpokes Information Technology platform allows organizations to build Pharmacy Benefits Management Systems without any investment on IT.

Components of RxSpokes include:

Definition of Formulary with clinical and rebate considerations, defining the TPA parameters and defining accounts and PLANs.

PLAN definition includes Group, Tier, Copay, Co-insurance and deductibles (deductibles can be RxOnly or MD plus Rx).

Members of a PLAN can have multiple attributes some of which can be member optional.

RxSpokes includes role based access to the data including access by clinicians (for example for Prior Auth and Step Therapy) and access by Customer Service Reps to answer member questions.

RxSpokes provides numerous reports.

The Platform as a service allows management of pharmacy network including independents, mail order, specialty and chains. It allows for multiple levels of pharmacies.

RxSpokes also allows for maintaining plans by uploading Excel files via SFTP.

RxSpokes is implemented on Windows Platform – it is cloud deployed – SQL SERVER database engine. It provides for real-time changes to the data.

RxSpokes has a built in Claims Engine to adjudicate claims which can defined differently for different PLANs.

RxSpokes is HIPAA compliant.

Contact us to learn more.