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Health Plans

abarca health offers the full suite of PBM services to many different types of private and public health plans and employer groups, including Medicare, Medicaid, and commercial plans. We have considerable experience in Medicare Part D plan management and provide value added solutions for Part D plans such as PDE record management, Medication Therapy Management (MTM), and formulary development, submission and maintenance. We work with health plan sponsors either through health insurance companies, brokers, or directly contracted. We can easily implement pharmacy “carve out” arrangements or integrate our offerings with our customers’ medical plans. Our customized report management tools and transaction processing capabilities facilitate a flexible approach geared towards helping our clients make better decisions and saving money.

Sample Client: Pharmacy Insurance Corporation of America (PICA)
Description: Medicare Prescription Drug Plan
Solution: Pharmacy Benefit Manager and Technology Solutions Provider

We have served PICA with customized PBM and technology solutions since 2005. In addition to traditional Part D PBM services such as formulary management, transaction processing, utilization management, PDE records management, and network development and maintenance, abarca health has developed and maintained applications for enrollment, Medicare compliance, and premium collection management. The efficiencies and flexibility provided by our proprietary claims processing engine have helped PICA become and maintain itself as the Puerto Rico market leading Medicare PDP.