The Formulary Administration/Rx Transition module is designed to identify outlier claims (paid/rejected) inconsistent with the CMS approved formularies and Rx transition rules. The process of reviewing thousands of claims to ensure rejected or transition prescriptions are consistent with your Plan's formulary can be inefficient and use valuable pharmacy department resources.
"While most sponsors delegated the implementation of key formulary functions to their PBM, they did not ensure the functions were in compliance with CMS requirements." - CMS 2011 Program Audit Findings & Best Practices (Jan 20, 2012)
Cadre360® provides Formulary Administration and Rx Transition software that automatically compares every claim (paid/rejected) with the approved formulary's drug index, Tier, Quantity Limits, Prior Authorization, and Step Therapy. Resulting actions taken by the pharmacy department can be documented and linked to each individual claim to facilitate retrieval at the request of an auditor.
Our software's algorithms streamline the process and significantly reduce the amount of time spent by the Pharmacy Department on this complex but important oversight requirement.
Why use valuable pharmacy resources to do a job that the new Cadre360® Formulary Administration/Rx Transition tool can do at a fraction of the time and cost?
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