Coordination Benefits / Formulary Support Services

PFSP is under contract with several major health insurance providers, including Medicare and Medicaid. We work with patients who are dual-eligible under these or other plans, as well as their providers to decide which benefits should be covered under which plan and avoid duplicating benefits under the same plan. We will determine a primary and a secondary plan. The primary will cover the benefits that patients are eligible for as if the secondary plan didn’t exist. The secondary plan may be used once the primary benefits are exhausted. Our formulary support services help our patients determine which drugs are covered under their specific plan.

Information Systems And Real-Time Reporting

To help our patients manage their condition, we must maintain complete communication between patients and their medical providers. URAC stresses the importance of quality patient care, which comes from keeping engaged with patients. Our certified specialty pharmacists and technicians utilize patient text messaging and other technology to share information about medication, billing, and real-time data relevant to treatment management. Our goal is to ensure our patients and their insurance provider that we have patients’ best interests and provide the quality care needed.

Partial Fill Dosing Management Services

If we determine that not enough medication is in stock to provide a full dosage in the time that patients need it, we offer partial fill services so that patients can continue to take medications as prescribed. Additionally, if the standard dosage isn’t necessary for certain conditions, these services help cut costs for patients and their insurance providers and reduce waste.

MTM (Medication Therapy Management)

At PFSP, our number one goal is for patients to have the best therapeutic outcomes from their treatment and be on the way to daily comfort and success. We will regularly conduct health status assessments to ensure a positive response to treatments and address any adverse health effects head-on. We also stress the importance of understanding everything about medications: from the purpose it serves to the dosages needed, to the side effects that may be experienced. It is crucial to have this understanding to treat conditions correctly. Under MTM requirements, we must have a close working relationship with our patients’ medical provider and make them aware of patients’ progress with their medication. We will refer patients to their provider should they experience complications that need broader medical assistance.