Using Data to Identify PBM Errors

Pharmacy Reimbursement of  $35,000


  • New Excelsior Solutions client appeared to have member over-payments in data collected in RxMart
  • Members were paying their full copay even though the total cost of the prescription was less


  • Excelsior Solutions pointed this out to the PBM
  • PBM agreed this was an error in their system and members had been over-charged

Client Win

  • Members reimbursed a total of $35,000

  • If ongoing data feeds weren’t being collected in RxMart, over-payment would have continued to go unnotice

Monitoring claims data 
ensures accurate