Every case has a different situation. Your staff may not have the
solution, but generally knows what your company needs as an end
result. SCS offers the due diligence necessary to understand first,
then apply our knowledge and experience to solve your problems.
3 Phases to Success
Our system is unique but simple; we find the issues
that are wrong, correct the mistakes and then monitor to insure
success. We think of the process as a complete and continuous circle
Stephens Consulting Services (SCS) utilizes proprietary PBM audit
software that is second to none. We inspect every aspect of the
processing procedure on 100% of your pharmacy claims data. Our software
is designed to mimic a correct PBM processing, starting with the
standard AWP source of either Medispan or First DataBank. With an
input of the details of your benefit design, the audit software
will highlight any and all discrepancies and calculate the overcharged
With the audit results, we work with you and your PBM to correct
both the processing errors and needed changes to your benefit design.
Often there are hidden issues that can only be revealed by the audit.
SCS has developed Script Probe® - a set of reports that will
show potential weaknesses in PBM processing and possible changes
that will help reduce the pharmacy expense.
An obvious cost-reducing change would be to negotiate better contract
terms. Because we are auditors and have past provider and PBM management
experience, SCS can help you negotiate the best possible contract.
If the issues are not satisfactorily corrected by your PBM and
your decision is to change your PBM relationship, SCS has the knowledge
and experience to guide you through the PBM selection process. Our
RFP procedure is unique due to our previous PBM management and auditing
experience. We do not depend on “spreadsheet analysis”
but will inspect each PBM candidate on how they process claims and
edit benefit rules. The selection decision is yours, but you will
have a better understanding of how each PBM makes profit and which
one would have the best service and financial outcome.
With the current PBM status corrected and all benefit changes in
place, the next step of our process is to monitor compliance- to
“inspect what we expect”. SCS will work with you and
the PBM to gather monthly pharmacy data for review. Quarterly audits
and monthly data checks will insure correct pricing and drug coverage
processing are accomplished. We will also monitor expected results
with our Script Probe® reporting.
The result of our 3 Phase Process is complete knowledge of your
pharmacy benefit and a feeling of control of the pharmacy expense.