Pharmacy Benefit Management Strategic Partners:

These strategic partners offer a variety of services to assist PACE organizations with the management of Part D benefits. These include the following:

  • pharmacy network contracting;
  • prescription drug claims processing and adjudication;
  • rebate submission and payment;
  • TrOOP (True Out Of Pocket costs) reporting;
  • support in implementing the PACE organization Part D compliance and Fraud, Waste and Abuse Program;
  • assistance in complying with CMS Part D reporting requirements;
  • prescription drug event submission and reconciliation;
  • pharmacy help desk administration; and
  • management and utilization reporting.

Pharmastar

Pharmastar offers a range of services specially tailored to meet the needs of the PACE industry. With over 20 years of experience, Pharmastar is a PACE-focused Pharmacy Benefits Manager that provides organizations with Part D administrative, compliance, reporting, and clinical services and support. Let us worry about Part D so you can focus on your participants.

We offer the following services:

Administrative Services

  • Claims Processing and Payment
  • PDE Management
  • TrOOP Support, Including AutoTrOOP Processing
  • P2P Management
  • Part D Bid and Reconciliation Support
  • Government and State-Level Reporting
  • Encounter Data Support and Submission
  • DIR Rebate Administration
  • Executive Summary Reporting Suite
  • Executive Benchmark Reporting

Compliance Services

  • 1/3 Financial Audit Assistance
  • Pharmacy Audit and Oversight
  • B vs. D Reporting
  • ESRD Benefit Support
  • Enrollment Monitoring Assistance
  • CMS Memo Support
  • Acumen Support

Clinical Services

  • PACE-Specific P&T Discussion Forum
  • DUR Programs
  • MTM Program Development Support
  • Access to Clinical Pharmacists with Part D Expertise
  • Clinical Pharmacist-Led Utilization Review
  • Clinical Reporting
    • Polypharmacy
    • Beer’s List
    • Psychotropic
    • Anticholinergic
    • Opioid
    • Targeted Medication Class
    • Clinical Benchmarking

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SeniorScript

SeniorScript is a clinically focused pharmacy management company that specializes in the specific needs of frail and elderly individuals, addressing all pharmacy-related health plan management functions. SeniorScript systems and software have been customized to allow greater control in adjudicating claims for complex patients, managing specialty pharmacy networks, and providing data in a manner and format that allows for timely action.

SeniorScript offers the following features and benefits:

  • Manage Cost Trends: We take a total health care value approach to building and maintaining pharmacy benefits to proactively manage trends in formulary management, clinical programs, utilization management programs, specialty pharmacy, home delivery and retail networks.
  • Drive Medication Adherence and Quality Care: Our clinical care programs improve safety and optimize member health through monitoring and engagement. A range of clinical and utilization management strategies help ensure safe medication use, improve formulary adoption, and promote cost-effective treatment options.
  • Proactively Engage and Support Members: Every member interaction represents a chance to make a difference in member health and total health care costs. Our innovative 360 Opportunity Alert System connects data to highlight engagement opportunities that can help members save money and improve health outcomes.

Contact

There are more than 240 PACE centers in 31 states. Find your local PACE program.

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