KBS RxM — Making Pharmacy Benefits Better

The KBS RxM program manages cost, ensures superior client and member service, and delivers comprehensive decision support for your organization’s pharmacy benefits.

In the U.S. today, significant health care dollars are spent on pharmacy benefits. With that, a laser-focus on managing pharmacy benefits is critical to ensure they are being utilized appropriately and wisely – both to help your employees improve and maintain their health, and to mitigate their impact to your bottom line.

KBS RxM can help contain costs, manage vendors, and manage risk through:

Comprehensive compliance audits
State-of-the-art clinical management services
Strategic financial modeling and reporting
Innovative cost savings programs

Proven Savings.

The KBS RxM audits and daily oversight save between 5-6% of your annual drug spend.

Compliance Audits

KBS RxM conducts a thorough audit of your pharmacy program and vendors, including Pharmacy Benefit Management (PBM) Contract Pricing - ensures all discounts and fees in your PBM contract are being properly adjudicated.
Plan Design - verifies that member copays are being correctly adjudicated.
PBM Formulary - authenticates that members are being charged the correct co-pay for each drug class and tier.
Clinical Prior Authorization Reviews - performed by a clinical pharmacist who assesses all clinical prior authorizations for our client members and also intervenes with the PBM to make corrections.
Fraud, Waste & Abuse Mitigation - develops strategies that flow from Fraud, Waste & Abuse audit results.

Clinical Management Services

KBS RxM ensures your members get the right drug at the right time.

Medical Management reviews and evaluates the drug-to-drug interaction reports, maximizing the opportunity to identify and manage medical conditions.

Specialty Rx Step Therapy categorizes therapeutic drugs from least to most costly. Members try the least expensive drug first to see if it’s successful; if it is not, your members move up to the next drug in the step program.

Opioid Management actively oversees this important and often abused class of drugs through a combination of audits, clinical prior authorizations, physician appeals, and step therapies.

Oncology Management uses your organization’s historical data and industry benchmarks to recommend oncology protocols that maximize member outcomes at the lowest possible costs.

Financial Modeling & Reporting

KBS RxM provides plan design and program recommendations including:

Annual Strategic Plan consisting of plan design and program recommendations, financial modeling, implementation, and reporting.
Financial Reporting consisting of quarterly, actionable utilization and financial reports.

Cost Savings Programs

KBS RxM programs help save both your employees and your organization money:

Over-the-Counter (OTC) Step Therapy Programs evaluate, implement, and model the ROI for any OTC program that may be advantageous for your plan and your members.
Retail Generic Programs recommend plan designs that increase members’ use of special discounts by retailers and networks.
Patient Assistance Programs identify the high-cost drugs being used by your members, then contact drug manufacturers who have co-pay assistance and subsidy programs to see if patients qualify.

Risk Management Services Summary

Encompassing all aspects of pharmacy benefit management to maximize outcomes for your plan members.

The KBS RxM ongoing risk management program encompasses all aspects of pharmacy benefit management — clinical, financial, member service, client service, and strategic planning — while maximizing outcomes for your plan members.