MEDICARE MANAGED CARE

Medicare Managed Care plans face a multitude of challenges and competing priorities every single day. At the center of this complexity is the ongoing effort to ensure that your members receive quality and value in the health care services they seek from providers.

Your pharmacy management program shouldn't take time and energy away from this effort. Pharmastar is a pharmacy benefit manager with services designed specifically to ensure your staff spends their time providing care to your members, not on pharmacy administration.

To learn more about how Pharmastar can help streamline your Medicare Managed Care plan's pharmacy benefit operations, contact us today!.

Plan Finder Support

The creation and regular maintenance of files required as part of the CMS Plan Finder submission can prove to be a heavy burden for Medicare Managed Care plans. Pharmastar has the resources and expertise to assist with this ongoing process on the behalf of its clients.

By removing the administrative hassle of this process, your organization is able to focus its time on meeting the needs of your participants.

Medicare Part D Assistance

The reporting and requirements of Medicare Part D continue to grow every year. This adds a significant burden to Medicare Managed Care plans and forces them to spend significant resources managing these processes.

To help alleviate the burdens generated by this growing area of administration, Pharmastar offers:

  • Direct and indirect remuneration support. This includes regular reports and CMS annual attestation.
  • PDE support. With increasing CMS requirements for pharmacy drug events, Pharmastar can help plans with the submission and correction of these filings. In addition, clients also receive detailed monthly reports along with yearly filing attestation.

Electronic Prescription Adjudication

Using the powerful engine of Catamaran for the prescription adjudication process, Pharmastar quickly and effectively accomplishes clients' claims processing needs.

Robust Reporting

Your organization faces an array of challenges in handling Medicare Managed Care. Pharmastar recognizes the impact of these challenges and develops reporting tailored to those needs.

Clients have access to a library of regular utilization and financial reports. In addition, Pharmastar works with its clients to develop ad-hoc reports that suit the specific needs of each organization. In addition, your data belongs to you. All clients have full access to the raw data available through any and all reports.

Clinical Support

Pharmastar also offers a wide array of clinical support for its clients, including drug utilization reviews with a PharmD who is board certified in geriatrics and pharmacotherapy, quarterly pharmacy audits and a Medicare-specific P&T committee.

Pharmastar provides clients with regular pharmaceutical alerts and recalls along with 24/7 access to its Pharmacy Help Desk.

Medication Therapy Management

Pharmastar's medication therapy management program is available to all Medicare Managed Care clients. Though this cost-saving program, Pharmastar flags members dealing with complex medical conditions verifies appropriate use, expected utilization and overall medication adherence.

In addition, a pharmacist can reach out to members directly and provide counsel them on ways to better manage their health conditions and prescriptions.

Guided Program Implementation & Development

Pharmastar clients experience personalized hands-on service from the very start of their partnership with our PBM. Every client has access to their own dedicated client support specialist.

Serving in a concierge function, this specialist works closely with a plan with everything from the very early stages of program implementation to regularly day-to-day operations. In addition, Pharmastar provides regularly monthly calls for its clients.

Formulary Maintenance & Assistance

Pharmastar can assist your plan in managing and processing the monthly submissions required by CMS.