Pharmacy Consulting & PBM Solutions for Health Plans and Partners
At Rebellis Group, we specialize in health plan support including pharmacy benefit management (PBM) consulting, delegation compliance, and operational support for Medicare Advantage, Medicaid, ACA, and commercial health plans. Our experts provide end-to-end solutions to optimize pharmacy operations, reduce costs, and ensure regulatory compliance in an evolving healthcare landscape.
Health Plan PBM Strategy & PBM Delegation Oversight
PBM RFP Development, Selection & Re-Contracting
End-to-end support for PBM procurement, contract negotiations, and vendor selection to align with financial and operational goals.
PBM Transition & Implementation
Seamless PBM onboarding, system integration, and contract execution to prevent service disruptions.
PBM Oversight & Audit Support
Ongoing PBM performance monitoring, compliance audits, and contract adherence assessments.
Comprehensive Pharmacy Services
Our pharmacy consulting team brings decades of experience to support your organization’s full spectrum of pharmacy-related needs, including:
Regulatory Compliance & Operations Support
✔ Part D Operations Re-Engineering
Identify inefficiencies and streamline processes for pharmacy operations including PDE management, claims processing review and oversight, PDE management, and required CMS and compliance reporting.
✔ Benefits Administration Testing
Pre- and post-implementation benefit testing to ensure accuracy and prevent costly claim errors.
✔ Paid and Rejected Claims Review & Resolution
Analyze and resolve inaccurately processed rejected pharmacy claims to minimize financial risk and improve member access.
✔ Formulary Administration & Compliance
Ensure CMS formulary compliance while optimizing medication access and cost efficiency.
✔ Formulary Management Strategies
Develop data-driven formulary strategies to balance cost containment and member satisfaction.
✔ Part D Stars StrategiesMedication Therapy Management (MTM) Optimization
Strengthen Star strategies to improve MTM programs to improve Star Ratings, patient outcomes, and medication adherence strategies to improve patient outcomes and overall Star Ratings.
✔ Prescription Drug Event (PDE) Management & Reconciliation
Accurate PDE submission, reconciliation, and compliance support to minimize financial risk and maximize rebates.
✔ Medication Therapy Management (MTM) Optimization
Strengthen MTM programs to improve Star Ratings, patient outcomes, and adherence strategies.
✔ DIR & Rebates Strategy
Comprehensive Direct & Indirect Remuneration (DIR) analysis to maximize rebate potential and improve financial performance.
M3P: Medicare Prescription Payment ProgramPart D Pharmacy Compliance & Performance Program
Rebellis Group offers M3P (Medicare Prescription Payment Programart D Pharmacy Performance Program) to support health plans and vendors PBMs in meeting regulatory requirements and optimizing Part D performance.
M3P services include:
✔ M3P Assessment and Gap Analysis for CMS Compliance
✔ CMS Program Audit Readiness
✔ Medication Adherence Strategy Development
✔ Part D Compliance & Risk Management
✔ Star Ratings Improvement Initiatives
✔ Formulary & Utilization Management Compliance
Specialized Pharmacy Consulting Services
✔ 340B Program Compliance & Optimization
Navigate the complexities of the 340B program, ensuring compliance and operational efficiency.
✔ Specialty Pharmacy Strategy
Develop strategies for high-cost specialty drugs, ensuring optimal coverage and affordability.
✔ Pharmacy Network Strategy & Risk Management
Optimize pharmacy network design to balance access, cost control, and compliance.
✔ CMS Audits & Mock Audits
Prepare for CMS audits with thorough mock audits, risk assessments, and remediation planning.
Why Partner with Rebellis Group?
✔ Deep Industry Expertise – Our consultants have decades of experience in PBM oversight, Part D compliance, and formulary management.
✔ Comprehensive Compliance Support – Stay ahead of evolving CMS regulations and audit requirements with our proactive approach.
✔ Tailored, Data-Driven Strategies – We customize pharmacy benefit solutions to fit the unique needs of your health plan.
✔ Proven Results in Cost Optimization – We help health plans reduce costs, optimize pharmacy networks, and improve Star Ratings.