Expert advisory services for Medicare Advantage Part D and Prescription Drug Plans

The rapid changes to Part D regulations make the tracking and implementation of CMS requirements exceptionally difficult. The challenge is further magnified by the necessary reliance on delegated entities to perform critical Part D functions. GHG’s pharmacy experts offer a broad array of services that support PDPs and startup Part D operations through operational assessments, pharmacy benefit management (PBM) selection and implementation, management of Prescription Drug Event (PDEs) and claim checks, interim staffing, and surveillance through delegation and mock audit processes.

Our services are designed with your staff in mind, ensuring that your team has access to the expert guidance and tools they need to increase efficiency, reduce costs, and alleviate compliance risk.

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Medication Adherence

An effective medication adherence program can not only have a profound influence on a patient’s well-being, quality of life, and health outcomes, but it can also positively impact medication and the associated utilization costs from a plan perspective. Our team of pharmacy experts advise on the identification and removal of adherence barriers while isolating patient-specific factors that cause or influence lack of adherence.

Benefit Administration Testing

GHG’s pharmacy experts can design and conduct an in-depth benefit administration test for your organization that will validate whether everything is working precisely as it intended before the new plan year begins. We will also help you implement a system that will track validation on an ongoing basis throughout the year. GHG can ensure that your PBM is processing claims consistent with your CMS-Approved Prescription Drug Benefit.

Delegation Oversight

In today’s regulatory environment, it’s critical that your PBM and other delegated entities perform flawlessly. With GHG’s in-depth delegation oversight assessments, our experts can help your organization learn how to identify potential issues and address risk, empowering your teams to ask the tough questions.

Operational Assessments & Mock Audits

Achieving operational excellence begins with identifying your organization’s strengths and weaknesses. GHG’s team of veteran experts provides expert guidance related to regulatory and operational issues to help alleviate risk for the Prescription Drug Benefit program. Using our broad array of services and unmatched compliance tools, we will help your MA-PD or PDP implement efficient and compliant internal operations that will prepare you for CMS audits.

Pharmacy Benefit Manager Selection

The right PBM can be a powerful ally in keeping prescription drug costs down and improving health outcomes, but selecting the highest quality PBM can be overwhelming, costly, and time-consuming. GHG’s team of pharmacy experts can help you research and evaluate PBMs by using data from pharmacy and medical claims, as well as proven technology, to gain insights into your current pharmacy program to best determine which PBM is right for you.

Interim Management

If you are looking for a seasoned veteran, GHG can enrich your team with our own, providing the leadership and knowledge your organization needs. GHG’s pharmacy experts can supplement your existing team with able professionals who have years of experience providing strategic services to the industry.

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