Pharmacy Benefit Management (PBM) Solutions

abarca health provides PBM solutions that help our clients lower their pharmacy costs, improve their benefit programs, elevate their quality of care, and streamline their operations. Our internally developed and continually enhanced pharmacy benefit management technology platform is the core of our competitive advantage in PBM services. Our technology focus combined with our team’s clinical and market knowledge enables us to implement solutions that meet our clients’ drug benefit needs at a low cost. Our approach combines clinical and benefit consulting with operational improvements and decision support at every step of the process. We are committed to developing close partnerships with our clients to best serve their beneficiaries and help them save money. Learn more about our full suite of PBM capabilities below:

  • Benefit Design and Management
    • Benefit Design Consulting
      Benefit Setup
      Eligibility Management
      Transaction Processing and Adjudication
      Claim Adjustment Activities

  • Formulary and Pricing Management
    • Formulary Development, Management and Submissions
      P&T Committee Management
      Rebate Negotiation, Billing and Collections
      Maximum Allowable Cost (MAC) List Development and Maintenance

  • Clinical and Utilization Management Services
    • Medication Therapy Management
      Prior Authorizations
      Drug Utilization Review
      Coverage/Exceptions Determinations
      Academic Detailing
      Medication Adherence Programs

  • Provider Network Management
    • Retail Pharmacy Network Development and Maintenance
      Mail Order Pharmacy
      Specialty Pharmacy Programs
      Provider Audits
  • Beneficiary Services
    • Beneficiary Call Center
      Card Generation and Distribution
      Member Orientation and Communications
      Clinical Interventions
      Grievances and Appeals
  • Medicare Part D Specific Services
    • PDE Record Management
      Compilation and Submission of CMS-Required Reports
      CMS Audit Support
      CMS Required Member Communications
      Explanation of Benefit Production and Mailing
  • Custom Pharmacy Program Implementation
    • Discount Cards and Savings Clubs
      Loyalty Programs
      Medication Adherence Programs