PSRx Advisors is a leading next-generation health information entity built to support the Public Sector and specific to pharmacy benefit oversight. PSRx Advisors specializes in providing pharmacy program consulting services & solutions to public state and federal programs.

PSRx Advisors offers unique Fraud Waste and Abuse (FWA) monitoring tools to ensure a comprehensive assessment, incorporating a review of 100% of claims consistent with your FWA strategy. Our tools enable your plan to maintain a vigilant oversight effort consistent with your FWA strategy.

Fraud Waste and Abuse – A view from Multiple Data Sources
There are multiple challenges in tracking Fraud Waste and Abuse that may not be fully captured in PDE data or source claim analysis and require medical data inclusion. Verification of the following requires dynamic tools that integrate various data sources to confirm suspected cases of FWA. Examples of FWA monitored include:

• Outlier utilization
• High cost claim monitoring
• Inappropriate pharmacy network pricing
• Multiple members utilizing one card
• Narcotics monitoring
• Paper claim submission integrity

Medical data inclusion enables a broader FWA oversight effort:

• Diagnosis and procedure review to verify the right drug was used for the right reason
• Specialty drug dispensing to verify corresponding disease diagnosis
• 100% of claims review methodology

Immediate response opportunity for your plan
Our reporting criteria are dynamic and adjust based on your data patterns. Reporting is calibrated for immediate web access or daily push reporting, enabling unsurpassed independent monitoring of claims activity. Report cards are generated on frequency designated by you.

PSRx Advisors delivers pharmacy savings and oversight tools
PSRx Advisors is a leading next-generation health information entity built specific to pharmacy benefits. We provide data audits, risk analysis and applications that support a thorough oversight strategy for health plans. Our suite of software applications, expert audit and consulting services assist you in controlling pharmacy program and healthcare costs.

The same level of guidance that was once reserved for healthcare is now warranted for pharmacy. Increased concern for specialty pharmacy, contract transparency, mail order, and consumerism requires a hands-on approach to maintain strong pharmacy management. PSRx Advisors' tools enable you to maintain a hands-on approach to PBM vendor adjudication issues and incorporate the oversight into your global health program management strategy.