FAQ'S

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Timelines – high level: For new groups, 90-120 days allows for file transfers and testing. 30-60 days is achievable, however prior planning and testing cannot be accomplished in 30-day implementations.

The Ascend Implementation Process:

  • Obtain and review current benefit plan design, review contract, outline vendor relationships and determine changes/goals to develop plan overview
  • Review most recent claim data, assess current programs
  • Implementation Kick-off Meeting
    • Assign Team Leaders
    • Establish Meeting Schedule
    • Discuss major operational areas - identify goals and challenges
    • Account structure
    • Eligibility management
    • Plan design build
    • Formulary and clinical programs
    • Data exchange to support combined OOP and accumulators
    • Data to third party vendors
    • Transition files: Prior authorizations, mail and specialty open refill files, claim history
    • Member communications, including ID cards, welcome package and open enrollment support
    • Additional communications if needed
    • Reporting
    • Invoicing
    • Client specific initiatives
    • Finalize Agreement
    • Create general, overall timeline
    • Track to the goals, schedule, deliverables and milestones
    • Testing of technical connections – eligibility, benefits, invoicing, reporting
    • Go live/monitoring
    • Ongoing oversight

Begin with a detailed kick-off meeting where we identify the client’s specific benefits philosophy, challenges and goals, and assign leadership. We strive to minimize or eliminate disruption to members and provide effective recommendations and guidance on issues unique to the client’s organization and business environment.

Invoices are to be paid per contract terms, generally upon receipt or within 2-4 days and Clients are generally invoiced on the 15th and the 1st of the month (depending on weekend days). Generally, we do not require upfront funding for PBM claim processing, unless a credit check reveals slow pay tendencies. For clients with a history of slow pay, a deposit may be required. Contact terms generally state that lack of payment will result in termination; reinstatement can occur with a minimum amount (ranging from 1-6 month’s invoice total) held in escrow. PBMs must adhere to prompt pay provisions and pay their network pharmacies on a timely, scheduled basis, many times before the client pays the PBM.

Clients generally receive two invoices twice a month, payable within 2-4 days:

  • Drug Spend including ingredient cost, dispensing fees, sales tax, etc.
  • Administration or management fees

These can all be built in, and vary based on services included and the overall structure of the deal. Administration fees are common in pass-through model and are much less in traditional structured arrangements.

Our PBM program supports multiple formulary tiers including: open 2-tier, open 3-tier, 3-tier with exclusions (closed) are most common.

Customization often impacts rebates and can be challenging to maintain; discussing the type of customization is important during the onboarding process. Clients will want to have an understanding of the formulary structure in relation to the expected rebate payments. Often a varied degree of customization can be accomplished by working with the Ascend team during the Plan Design process.

  • Excluded categories such as cosmetic or lifestyle products is generally allowed
  • Excluding specific drugs may impact rebates
  • The drug in question needs to be evaluated for efficacy and lowest net cost
  • Multiple drug exclusions are generally not supported due to rebate impact and challenges to maintain adjudication coding over time.

PBMs who offer customized formularies often charge $100K or more annually for development and/or maintenance.

AscendPBM’s program offers multiple network choices:

  • Open network (approximately 68K pharmacies)
  • Preferred networks (exclude one large chain such as Walgreens or CVS)
  • Custom networks for clients with their own dispensing capabilities

Because of their commitment to providing meaningful value to Ascend PBM and Ascend’s clients, the pharmacy network is open to allow OptiMed’s dispensing of specialty meds, and Advanced Therapeutics to dispense compounded prescriptions.

Additional options allow exclusive 90 days supplies from CVS and Target retail locations to process at mail order discount rates and rebates.

See #5

Ascend PBM excels in communication and issue resolution. Toward that end we support a three-prong approach:

  • Pharmacy Help Desk to provide immediate response to pharmacists within the network
  • Account Management with direct access into operational departments for timely response and resolution
  • Member Service representatives are that are familiar with Ascend PBM’s client processes and needs

Ascend offers both Standard and Ad Hoc reporting available through the online system. Robust, standardized reporting packages are readily available at the group level and in the time increments you choose. Ad Hoc reporting allows users to create reports based on claims with frequent refreshes. Clients may or may not have direct access into the reporting system but will always have a direct contact to request reports and receive data in a timely manner. Ascend strives to provide meaningful, actionable data to support a holistic approach and fine tune your pharmacy benefit plan.

Additionally, to meet Client’s needs, quarterly, semi-annual and annual meetings are available with Ascend PBM staff to discuss market conditions, trends, and solutions for controlling costs.

Clients or their TPA/ASO staff can make eligibility updates directly in the system as needed. Ascend PBM supports frequent eligibility file loads with comprehensive policy and procedure supported by standardized formats to ensure timeliness and accuracy.

Ascend PBM can assess and model all aspects of the pharmacy benefit for financial and member impact as well as member disruption. To improve both cost and utilization, we focus on formulary, network, plan design, as well as clinical and administrative programs to determine what is most beneficial with the least disruption.

PBM marketplace contracts are generally three-year deals. Ascend PBM offers both one and three-year options to meet the client’s needs.

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