Clinical Audit

Do you know where to look in your plan to improve the health of employees and reduce costs? You need up-to-date and ongoing assessments of all the features of your needs and the offerings of your PBM and health plans.

IHC’s in-depth Clinical Audit process and on-going management can be worthy resource for your firm’s benefit department.

Look at these features that you count on IHC to provide with their signature attention to detail and mastery of the industry :

  • IHC’s clinical pharmacists regularly review the drug utilization patterns for the client’s population. When specific disease patterns are identified that could be opportunities for improved member health and/or reduced plan cost, IHC works with the PBM to identify or modify utilization programs that will respond to these disease states. IHC also negotiates and evaluates guaranteed clinical program savings.
  • Quality assurance for plan design features is a key ongoing feature of our service, particularly for custom features not routinely part of the PBM’s or health plan’s standard offerings

IHC stays involved with the client on an ongoing basis, providing expert clinical consulting services on day-to-day pharmacy management issues.

  • Clinical management criteria review and recommendations
  • Advisory support on requests to override plan rules or clinical management denials
  • Educational support to the client’s benefits team
  • Facilitation of communications between the client and PBM/health plan

Account Management

  • Review key prescription drug cost metrics quarterly, based on PBM claims data.
  • Prepare Executive Summary of PBM reports and status of vendor performance guarantees, quarterly.
  • Review and assess pharmacy benefit plan performance annually, including vendor performance evaluation and recommendations for benefit plan changes.
  • Act as a Resource to client’s benefit department.
  • Ad hoc clinical support for employee appeals process