Pharmacy Benefit Services

Pharmacy Claims Processing: PDMI's flexible, proprietary system provides a wide array of customized pharmacy benefit design options. Our secure, dependable systems process claims and make them accessible to you in real-time without the need for expensive software or licensing.

Flexible Benefit Plan Design: We work collaboratively, focusing on your plan design and what's important to you. Custom edits support all types of copays, co-ordination of benefits and subrogation, along with customized point-of-service messaging. Eligibility options include real-time access at your fingertips.

Formulary Management: PDMI supports standard and custom formularies. Our standard formularies are designed to meet client objectives, whether it's reducing costs or maximizing rebates. Choose the options that best meet your needs.

Rebate Management Services: We have no hidden income, no hidden agenda. One hundred percent of the rebate monies received is passed on to our clients less a fully disclosed rebate management fee.

Nationwide Pharmacy Network: PDMI can customize a pharmacy network to meet your needs. Our network consists of more than 64,000 pharmacies, including independents, regional and national chains. You can use your pharmacy network, wrap our pharmacy network with yours, or have a customized pharmacy network. PDMI is pass-through and transparent. There is no hidden income from network contracts.

Mail Order and Specialty Pharmacy Services: At PDMI, you work with mail order and specialty providers of your choice. PDMI is an independent and privately owned company with no ties and no hidden income from mail order and specialty pharmacy contracts.

Clinical Solutions: Our clinical solutions help promote safe, effective lower cost medications, improve medication adherence and educate members. Our solutions are available on an a la carte basis, giving our clients the flexibility to provide clinical services in-house if that best meets their needs. Our clinical services include: Concurrent Drug Utilization Review, Retrospective Drug Utilization Review, Polypharmacy Monitoring and Alerts, Fraud, Waste and Abuse, Compliance and Adherence Programs, and Coverage Authorizations (prior authorization, step therapy, etc.).

Analytics and Reporting Services: PDMI provides easy, timely access to the detailed information you require to manage your business. Our standard report library, customized reports and analytics are available via web service or on a subscription basis. Quarterly Management Reports include drug utilization and spend trend analysis and can be customized to focus on your unique requirements.

Member Services: At PDMI you have the flexibility to choose the member services provided at the plan level. Options range from a simple pharmacy look-up tool to a client-branded member tool accessible via web portal or mobile. The client-branded utility provides pharmacy claims history, plan coverage, pharmacy price and location, and medication look-up. PDMI can also provide member welcome kits and member cards customized to meet your needs.

Member and Pharmacy Help Desk: Our call center agents provide timely, accurate assistance to members and pharmacies via toll-free numbers. Agents can enter overrides, prior authorizations, direct member reimbursements and universal claim forms according to client specifications.

Administrative Services: PDMI offers flexible billing cycles to meet your needs. We offer private-label billing supported by comprehensive reporting. 

The PDMI Difference

Great Service. It's more than just a phrase – at PDMI, it's the heart of our business. Our people are empowered to take action to ensure timely responsive service.

Our Independence. PDMI is a privately held company. We work for our clients – not shareholders.

No Conflicts of Interest. We're invested in our clients, not drug manufacturers, wholesalers or pharmacies.

Data Ownership. It's your data – you own it and we spell it out in our contracts.

Flexible. PDMI provides pharmacy benefit services on an a la carte basis. Use the PDMI services that fit your business model.


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