Client Center

General information

PharmAvail provides progressive pharmacy benefit management services that maximize the value of employee health benefits, while improving quality of care and containing costs. We believe in bringing value to each provider of, as well as those receiving services, in a continuum of pharmaceutical care. We, however, differ from our competitors relative to our advice to plan sponsors and our construction of pharmacy plan and formulary specifics. We do not factor drug manufacturer interests or profits into our pharmacy plan, decision process. While maintaining the health needs of our members as the primary concern, we proceed in both plan and formulary development based strictly on sound clinical evidence. When independent analysis of clinical therapeutic value, drug versus drug, is nonexistent, our Pharmacy and Therapeutics team generally proceeds by recommending coverage of the most cost-effective alternative to the plan. In order to limit the potential for therapy interruption, we supply physicians and other prescribing professionals with information they need to make informed decisions. We fully understand today’s demanding health-care environment, thus we work closely with both pharmacists and physicians to make the prescription process safe and efficient.

We listen closely to our clients and their need to reduce overall costs, while ever ensuring exceptional care. We empower our members to make informed choices through educational programs, wellness offerings and strong customer service support. When formulary decisions are made that require an alternative to a member’s medication to comply with plan specifications, two plan options remain available. First, prescribers are welcome to submit for “prior authorization” of a particular medication when they deem it clinically justifiable in a particular patient. In return, we promise an efficient and professional review of each prior authorization request. If “prior authorization” of a particular medication is declined, co-payment options exist that allow members continued access to the nearly all pharmaceuticals.

 

Frequently Asked Questions

1. Discuss your ownership. Are you owned by a drug manufacturer or health care corporation?

No. PharmAvail is a privately held corporation, independent of pharmaceutical manufacturers or drug store chains. We were established in 2001 by three pharmacists, each with unique experience as PBM executives, pharmacy school academics, and large government group pharmacy plan consulting. Each of the founders saw an industry need for an ethical and flexible manager of pharmacy benefits where a client could realize transparency through revenue disclosure, as well as serving as a partner willing to accept full fiduciary responsibility. The founders dedicated the company to meeting the needs of clients caught up in a rapidly changing industry, where their interests and those of their members, were not being properly served.

Being independent of drug manufacturer influence or affiliation, we are freed to develop unique, unbiased programs that conserve clinical value while ensuring cost savings for our clients.

 

2. Discuss how your formulary differs from your competitors and how it is more cost effective?

Clearly the PBM industry has, in large part, evolved in concert with brand-name drug manufacturers and their interests. It comes as no surprise to many clients as they continue to experience 15-20% and higher annual increases in drug plan expenditures. Millions of dollars continue to flow from drug manufacturer to PBMs in support of and ensuring continued profits for both. Thus, the cycle continues and client drug bills continue to increase unimpeded. The main consequence of all this is that most PBMs have lost sight of who they are contractually bound to serve, namely the client.

There is no doubt PBMs should, but often do not, manage their pharmacy plans keeping the client’s best interest in mind. Instead, they appear to be more concerned with their interests and bottom lines. When new, higher priced brand-name medications (approved by the FDA) reach the market when no therapeutic value over currently available drugs is
Evident, these medications are routinely added to most PBM formularies. This practice furthers the escalation of drug costs borne onto their clients, against the client’s best interest.

PharmAvail’s approach is diametrically opposed to this unmanaged “formulary drift.” The only legitimate way to develop formularies is through the use of “evidence based” research and clinical review. “Evidence based” formulary construction ensures the therapeutic needs of patients are met, while maximizing the conservation of client resources and controlling total drug expenditures. At PharmAvail, we proceed with formulary construction under “evidence based” parameters. Never should a higher- priced drug be added to a client plan when no therapeutic value over existing drugs can be proven.

 

3. When a drug is not available under PharmAvail’s standard formulary are coverage exceptions available?

Yes. When an exception is clinically justifiable through communication with the member’s physician or other health care provider, plan coverage is made available through the “prior approval” process.

 

4. Does PharmAvail have multiple formularies available for client choice?

Yes. In a plan conversion to PharmAvail from another PBM, we can easily match to the client’s previous formulary. In the situation where the client chooses an existing formulary, PharmAvail proceeds to generate and quantify formulary changes and recommendations. Such recommendations are only implemented after client review and approval.

 

5. What about member privacy?

Protection of the privacy of clients and members is tantamount to us. Because we process and transmit Protected Health Information on behalf of our clients, we have developed and implemented a comprehensive for compliance with the Health Insurance Portability and Accountabilty Act (HIPAA) as it applies to our business of managing pharmacy benefits. Under no circumstance would we breach patient confidentiality or disclose any private health information without prior and express authorization directly from a member.

 

6. Where is PharmAvail located?

Our main offices are located at 3380 Trickum Road, Bldg. 500, Unit 104, Woodstock, GA 30188 with satellite offices in Durham, North Carolina and Fresno, California. We can be reached by phone at 678-236-0403 or by facsimile at (678) 236-0404.