Services

Grane PBM provides end-to-end support including administrative, clinical and compliance services.

General Support

Part D Bid Support, Processing & Reporting

Grane PBM specializes in Part D administration for PACE organizations ensuring accuracy, regulatory compliance, and complete transparency. We facilitate all of your Part D needs from bid to close-out so your team can focus on participant care. Our services include:

Real-time Claims Price Adjudication

Tap into pre-established, aggressive discounts based upon our national network, wrap-around network, or PACE plans negotiated pharmacy contract.

State & Federal Reporting

Grane PBM provides holistic support for all regulatory reporting to meet both state and federal requirements including:

Continuous fraud, waste, and abuse (FWA) auditing and review
Competitive pharmaceutical manufacturer rebate program
PDE/DIR rebate attestations
Encounter data

Audit Support

Grane PBM supports your PACE organization in the critical time of a CMS Audit from receipt of Engagement Letter to Close Out. We ensure all deadlines are met, complete and accurate documentation is submitted and all CMS questions are addressed and answered in a timely manner. Our end-to-end audit support includes all stages of the audit process including:

Audit Engagement
Universe Submission
Audit Analysis and Reporting

Rebate Management

Grane PBM facilitates rebate management for PACE programs to help ensure that your organization is optimizing its cost savings on manufacturer rebates. We take the burden of negotiating with pharmaceutical companies off your plate while streamlining the process. Grane PBM handles all associated paperwork, follow-up, IT and data processing requirements and detailed rebate and annual DIR reporting. We ensure that your PACE program obtains all rebates that you are eligible for.

Provide CMS audit and bid support for rebate
Produce required PDE billing formats by the manufacturer
DIR reporting
Submission to rebate aggregator and management of all necessary follow-up

Robust Internal Reporting and Analytics

Grane PBM provides regular, customized reporting and analytics for your PACE organization including robust utilization and financial reports, clinical and financial forecasts and on-demand reports. We leverage data to help create efficiencies and cost savings for your organization.

Grane PBM utilizes sophisticated backend technology to analyze costs and how effectively rebates and the formulary are performing, allowing PACE programs to make just-in-time adjustments as needed. In addition, we provide the in-depth data necessary to meet Medicare Part D reporting requirements and help your PACE program adhere to associated regulations.

Additional Support Services

Continuous maintenance of PACE enrollment files
TrOOP Management
PDE submission and reconciliation
Integrated electronic billing systems
Backup pharmacy network

Clinical Support

Pharmacy network, 24/7 customer support, custom reporting and DUR programs

Grane PBM provides critical advice on what clinically appropriate medications can be obtained at the greatest cost savings, without sacrificing participant outcomes. We continually review your medications to incorporate the most cost-effective and clinically relevant medications. Grane PBM has a network of more than 68,000 pharmacies including a specialty network for limited distribution drugs.

Nationwide pharmacy network access
Pharmacy relationships for claims management, FWA monitoring and oversight
24/7/365 support and access to licensed pharmacists and technicians
Customized utilization reporting
Drug Utilization
Review (DUR) programs

Compliance Support

Pharmacy audits, financial audits and compliance reports

Quarterly pharmacy audits
One-third financial audit support
Complete transparency of PACE PBM
Complete list of compliance-based reports