Contingency FeeBased Rx Audit and ERISA Plan Asset
Contingency Fee-Based, Rx Audit and ERISA Plan Asset Recovery Service HR Specialty Products & Services Catalogue Executive Summary A No Frills Distillation of Vendor’s Marketing Collateral Thomas A Ference President & CEO Human Resources Mining & Distribution Co Locating, Validating and Accelerating HR Innovation Office: 219 -662 -0201 Cell: 630 -240 -2583 Fax: 219 -661 -0236 e-mail: tference@hrmdco. com Website: www. hrmdco. com
Contingent Fee Rx Audit & Plan Asset Recovery • All Rx audit services vendors focus on identifying anomalies and overpayments related to areas such as contract adherence on discount guarantees, miscategorization of drugs, benchmark unit pricing, etc. • However, once the errors are identified, these vendors fail to recoup the funds / ERISA plan assets as required by law. • This service provider offers a free-upfront audit of the last 12 months’ worth of Rx claims in order to assess the potential opportunity. • Takes only two to three weeks to get results from first 12 months audit
Contingent Fee Rx Audit & Plan Asset Recovery • If the client desires, thereafter the vendor will audit the remaining open years and retain a percent of savings contingency fee. • Minimal HR staff time required if auditor provided with a PBM authorization letter allowing auditor to access the Rx claims file • Conservatively, the program recovers between 2 -4% of the total pharmacy spend conducted over a 2 to 3 year retrospective audit of 100% of paid pharmacy claims. • An optional PEPM-based on-going monitoring and pricing concession service typically produces between a 5% and 10% additional savings
Sample Savings Per 1000 Employees Item Number of Employees 1000 Number of Total Plan Members 2400 Annual Rx Spend per Member $1, 000 Annual Rx Spend Total $2, 400, 000 (2400 X $1, 000) Assumed Savings Rate +3% of Spend $72, 000 (one year) Savings Over 3 Years $216, 000 Sales Equivalent at 10% Margin Rate $2, 160, 000 ($216, 000 / 10%)
Next Steps • This product/service is contained in the HR Specialty Products & Services Catalogue™ • Operational level details about this particular service provider can be obtained in conference with the vendor • The HR Mining &Distribution Co. is an independent and contracted representative of the vendor • Upon your request, we will arrange for an introduction that can range from a simple, quick conference call to a services overview / system demo • Tom Ference 219 -662 -0201 (Chicagoland area) or tference@hrmdco. com • Thank you for your potential interest in this fresh thinking
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