- Review of daily rejection file
- Review for proper coverage determination rejections, including: Prior Authorization required, Step Therapy criteria, Quantity Limits
- Policy and Procedure development and implementation with internal staff or client supported daily rejection management
- Best practices for daily rejection file and appropriate follow up on types of rejections to exceed Medicare Standards
- Review of messaging on rejection files to ensure pharmacies process correctly and decrease amounts of possible coverage determinations for products that have alternatives on formulary decreasing variable direct cost from PBMs on initial coverage determinations.
- Review of transition fill process and member letters
- Ensure that transition fills are properly processed by PBM and in compliance with Medicare Standards