Overview
Clients and Plan Sponsors
A Commitment to Transparency
Complete transparency is no longer an option. For payers struggling to reconcile rising costs with quality healthcare, it’s a non-negotiable requirement. You deserve the complete picture about the extent and nature of your PBM’s financial arrangements and transactions with pharmaceutical makers and pharmacies.
Fortunately, you can have transparency and quality pharmaceutical benefits without breaking the bank. That’s especially important if you’re responsible for the management of a pharmacy program — where you must balance the need to contain costs and adhere to clinically defensible guidelines.
MedMetrics Health Partners embraces full financial, operational, and clinical transparency at every step of the process. As a MedMetrics client, you get to see and receive all manufacturer rebates, enjoy 100 percent pass-through pharmacy pricing, and receive full disclosures of all revenue streams attributable to your prescription drug program. With MedMetrics, we align with you, so you know where every single dollar comes from and where it goes to — just as it should be.
We do not sell your utilization data to third parties, nor do we engage in behind-the-scenes relationships with pharmaceutical manufacturers that may compromise our independence and our ability to meet the best interest of our clients.
At any time, all of our decisions and processes are open for your review. We want our clients to understand that our decisions are made to benefit them and their members, not the PBM or outside interests.
Lower Costs Through a Solid Clinical Foundation
MedMetrics was founded by and continues to enjoy a strong affiliation with the University of Massachusetts Medical School. Our pharmacy benefits consulting, formulary development, and clinical programs are all rooted in objective, respected, trusted, and independent clinical research – not conflicting goals and commercial incentives.
Through well-grounded clinical programs and evidence-based medicine, MedMetrics drives better long-term outcomes and appropriate utilization to further control your costs.
Our Commitment to Clients as a Trusted Partner
As an organization with a firm commitment to meeting the unique needs of our clients, including state Medicaid and managed-Medicaid providers, MedMetrics offers an uncommon value proposition. We understand the need for frequent, detailed reporting, personal attention, and turnkey formulary recommendations based on a solid clinical foundation.
As a trusted MedMetrics partner, you enjoy the piece of mind of knowing:
- Our commitment to transparency is unwavering — You know where every dollar comes from and where it goes — just as it should be
- Our incentives are aligned — This includes a financial model based upon a per member per month (PMPM) administrative fee. There are no undisclosed payments or other hidden arrangements. Our business model aligns our incentives with your incentives: better care and lower costs
- We are committed to lowering your costs — Our innovation in clinical programs and affiliation with UMass Medical School is a key to achieving these cost advantages
- Fully dedicated account resources are assigned to your account — We devote a team to your account, including an account manager, clinical pharmacist, and data analyst
- Quarterly meetings will be provided — We meet with clients every quarter to review pharmacy benefits, assess strengths and weaknesses, and make improvements
- Insightful, customized reports are available — As part of our commitment to total transparency, we provide you with weekly, monthly, and quarterly financial reports. You see where every dollar goes
- Bi-Weekly New-Drug Monitoring services are provided — We closely track product introductions and provide clients with biweekly updates of these products along with our recommendations for drug-benefit management, claims processing coding, and/or P&T reviews
- Robust and Accurate Claims Processing is part of our best-in-class approach — Our IT systems are flexible to support custom plans and benefits and process millions of claims — efficiently and accurately. We use software that has processed more than 1 billion pharmacy claims for 108 million individuals
- Superb Member Support is a company-wide focus — Our call center is staffed with carefully screened, trained staff — including top-notch pharmacy professionals — who provide careful and thorough assistance to plan members and providers. Last year, we processed more than 150,000 clinical requests, resolving 98-percent of them within 24 hours
We will also work with a clinically defensible formulary and MAC list. Decisions are made based on sound clinical analyses and evidence — not conflicting agendas.
