CAPTURE the Advantage
CLM does all the work to bring the Patient, Prescriber & Pharmacy together! We do all the work, so the entire process provides an appealing and cost-efficient solution for the prescribers, pharmacies AND the patient.
Patient Benefits: Optimize patient consultation time; Identifies individualized patient solutions; Patients receive the most current healthcare options; Improve overall patient wellness; High quality medication at little to no cost to the patient; Convenience of home-delivered prescriptions AND Faster relief!
Doctor Benefits: Receive daily overview of program options for scheduled patient; Identify eligibility and needs for ancillary practice services; Enhance patient experience; Improve patient retention and loyalty; Increase each patient revenue potential; Compliant with all protocols and rating values of health insurance providers; No call backs from pharmacies for pre-authorization or drug substitution.
Pharmacy Benefits: Significantly increases revenue and margin; Optimize every patient's needs; Better medication management and drug coverage identification for patients; Coverage for high margin products verified at the prescriber level; Prescriptions are already pre-authorized and covered; No need for time-consuming substitution calls and therapeutic interchange; Labor reduced for cost savings.
Qualifying/Initial Assessment: CLM has the ability to run any subset of a patient population at any pharmacy- through its IT solution and determine, for each patient, and each PBM plan, by group, BIN and PCN- if most NDC numbers are covered- and if they are- what TIER Co-pay that NDC is classified under. So a pharmacy will get a customized report that tells them exactly what drugs are covered, under which plan, separated by BIN, PCN and GROUP and cop pay tier. This report will be used to both “qualify” a pharmacy to ensure that it makes sense to partner with CLM (meaning that the partnership would deliver significant value to the pharmacy), coupled with providing that pharmacy with an extremely valuable data set that they can use for script pad creation and as a platform to assist physicians with writing for scripts that are getting paid by their patients' insurance plans.
This process is manual and requires a remarkable labor model. In addition, CLM incurs transaction fees to execute this IT solution. CLM will cover its costs only. This is NOT a profit model.
♦ Depending on pharmacy size and volume, the above four report tiers will represent the majority of all PBM plans that a pharmacy population will see. CLM runs the top 10-15 generic drugs (single line topicals) AND/OR top 20 oral drugs PLUS all high margin ANDA/FDA approved Puretek products
Monthly: Drug NDCs update, fall off formularies and are added to formularies almost every 2 weeks or 30 days. That makes it very challenging for a pharmacy to track and react to successful adjudication trends.
CLM will provide monthly reporting to its pharmacy partners- by way of its R&D team, that will enhance that pharmacy’s agility and ability to maximize its revenue through the most recent adjudication trends. This will also help guide physicians on what drugs are actually covered for their patients- should one of these particular drugs be a chosen prescribing option.
Monthly R&D fee…same as above
Comprehensive Billing Solution:
This involves handling the entire “script process-“ starting when the prescription is faxed in from the physician office…data entry, adjudication, therapeutic interchange, patient outreach & physician outreach- is all handled by CLM. The pharmacy would only then have to print the successfully adjudicated script label, pharmacist verify vs the script and product then ship. This solution can significantly reduce that pharmacy’s labor model as the above listed time consuming functions are removed from that operation.
This is only legal under cover of a state pharmacy permit, supervised by a state registered pharmacist and data entry conducted by state registered pharmacy technicians.
Additionally, CLM must be have the state pharmacy permit of the state that CLM is remoting into. For example, if the CLM pharmacy partner is in Tennessee, CLM must have that active state pharmacy permit, in addition to a Florida pharmacy permit…and so on…
Fee Structures: There is never remuneration based off of Federal/Medicare/Government scripts. CLM will always qualify the pharmacy partner then look at a monthly billing fee- a FLAT FEE based on labor attached to script volume OR a 20% of Net Margin figure.
Pharmacies will be classified under one or the other fee structures based on payor mix, margins and other financials.
One Stop Shop:
This solution is in process. Expected completion time when this solution is available to CLM pharmacy partners- coming soon. This is a single outreach purchasing solution.
This solution allows CLM pharmacy partners to make ONLY one call or send one email- to purchase and all products needed including generics and Puretek products. No need to search multiple manufacturers and wholesalers for all the different needed products. Pharmacies are calling 3, 4, 5 or more entities daily just to find a product at the best cost or find an entity that carries it. This is one call, most competitive pricing, for all needed products.
Review and assess pharmacy’s operations including but not limited to workflow, infrastructure, SOPs, financials, leadership/personnel, purchasing, adjudication success and sequences/processes, customer service and patient & physician outreach mechanisms etc…
Many organizations are not structured at optimized levels to enable them to capture all possible revenue channels related to operational excellence and internal mechanisms.Consulting fees apply-$3500-$5000/Monthly.