Pharmacy Benefits Management

If an employer offers prescription medication benefits, the patient may think that he/she are getting their prescriptions directly through an insurance plan. The fact is that most health plans contract with a pharmacy benefits manager (PBM) to administer prescription drug benefits.

A PBM (QTAT) is a company that administers or handles, the prescription drug benefit component of your employer’s health plan.  A PBM (QTAT) processes and pays for your prescription drug claims and is responsible for assisting your employer with managing the prescription benefit.

As the name implies, a PBM (QTAT) is in charge of administering prescription drug benefits, with the ultimate goal of providing plan members with access to medications drugs while still keeping costs to a minimum. To achieve this goal, QTAT negotiates drug prices with pharmacies and establish a network of pharmacies that one can use to get their prescriptions filled, including QTAT mail-service pharmacy.

PBM (QTAT) also assists in developing Plan’s formulary or medication tiers, a list of medications covered under the patient’s Plan and the co-pay amounts. PBM (QTAT) helps to encourage the use of lower-cost medications, including generics, without compromising clinical effectiveness. PBM (QTAT) utilizes our clinical and managerial expertise to recommend and implement cost-containment measures, like requiring Prior Authorizations, Step Therapy Plans and Managed Drug/Dispensing Limits (refer to associated “Understanding…” articles). PBM (QTAT) uses rule-based programs to help reduce duplicate prescribing and medication usage. The pharmacists and Certified Pharmacy Technicians at PBM (QTAT) provide comprehensive clinical services to help patients get the most from what they spend on their meds.  PBM (QTAT) division is dedicated to helping patients and their employer access the best therapy for the lowest cost, without sacrificing effectiveness.

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