We take pride in being an advocate for employers trying to manage their employee benefit costs. We analyze and develop rates based on millions of claims. We provide our clients with routine audit services to confirm their contract terms are being met.
The FlexScripts Self-Funded Program (previously called Joinder) is for self-funded groups in competitively priced programs based on our pool of tens of thousands of insured.
We use an aggregated PBM contract by leveraging our book of business to identify the best PBM partners for our combined services. Our partners have market-leading pricing, as well as state-of-the-art claims processing technology. We review market pricing annually to ensure our clients benefit from the most competitive PBM contract pricing.
Clinical Oversight and Modeling
A FlexScripts clinical review identifies high-cost medications across numerous drug categories and verifies appropriate usage, dosage, and clinical appropriateness. Our unique approach allows us to better control pharmacy trends, and ensures the plan is being properly managed.
Specialty drug are expensive, and there are usually no generic substitutes. At FlexScripts, specialty drugs are our specialty.
We constantly analyze and develop rates quarterly, using actuarial factors derived from our own block of business, as well as the millions of claims we load into our data warehouse.
Quarterly Pricing Audits
FlexScripts continuously audits the claims administration process to ensure that both contract pricing and plan design are properly administered by the PBM. We ensure that every dollar an employer spends on their employee pharmacy benefit is being spent in the most cost effective manner.
Our audits also satisfy the fiduciary responsibilities of self-funded ERISA plans. A plan sponsor can elect to have the audit reports sent as frequently as quarterly, along with each claim invoice.