Call Us: (833) 633-6833 - info@synergyrxpro.com

FAQs

1. What is Synergy Rx?
Synergy Rx (SRx) is a Pharmacy Services Management company designed to help skilled nursing facilities proactively manage their sub-acute pharmacy spend. SRx assists SNF's in developing their own, independently adopted formulary, and then conducts real time adjudication on all claims in order to enforce that formulary. These adjudicated claims act as a platform to ensure accuracy of the SNF's pharmacy bill, helping clients save hundreds of thousands of dollars annually.

2. What is a formulary, how is it developed, and how is used?
A formulary is a list of preferred medications that a facility or organization adopts to help streamline ordering patterns for therapeutic equivalent medications. While the ultimate decision lies with the physician, compliance with an adopted formulary will allow SNF's to optimize clinical efficiencies and save money in multiple ways, over time. Synergy Rx assists clients in forming a Pharmacy and Therapeutics (P&T) Committee, and adopting a facility-specific formulary that makes sense for their organization.

3. I receive high cost medication alerts from my pharmacy. How does the formulary differ from this?
High cost medication alerts are dictated by each company, based on a maximum dollar amount they will tolerate (e.g., anything over $150). While these considerations are part of the development of a formulary, a formulary helps manage drug selection and usage for many more medications, not just those that are obviously more expensive. A formulary also takes clinical efficacy of medications into account.

4. Is a formulary used for all patients?
It is recommended that you use the formulary for all patients for which the facility is responsible paying for their medications. This includes Medicare Part A, most Managed Care Plans, workers compensation, etc. Some facilities have found it easier for their nurses to apply the formulary to admissions as well.

5. Other companies say they adjudicate claims and reconcile bills, what makes Synergy Rx different?
Synergy Rx is truly unique in its combination of claims adjudication, formulary management, reconciliation reporting suite and web-based interactive tools. Additionally, by participating in Synergy's platform, clients are eligible to receive forms of revenue to offset their monthly pharmacy cost. Other companies in the marketplace are claiming that they do similar services…we look forward to showing you how truly differentiated our platform is.

6. What is claims adjudication? Will my pharmacy do this?
Adjudication is the process by which a pharmacy sends a "request" to a Pharmacy Benefit Manager (PBM - i.e., Synergy Rx) PRIOR to dispensing a medication. This allows Synergy Rx to ensure the requested drug is on formulary, capture important information on pricing, and many other features. Your pharmacy "adjudicates" claims for all Part D and Commercial Insurance plans every day. In fact, the only prescriptions that they currently do not adjudicate are your Part A and Managed Care claims.

7. How does price reconciliation work?
SNF's typically receive their pharmacy bills on a monthly basis containing thousands of lines per facility. Additionally, LTCP contracts are extremely complex with different Wholesale Acquisition Cost (WAC), Average Wholesale Price (AWP) or Maximum Allowable Cost (MAC) discounts, based on the type of drug ordered. Contracted pricing will vary based on whether it is generic or brand, single source or multi-source, compound, IV, etc. This makes it impossible for SNF's to accurately review and audit their bills. Synergy Rx inputs the parameters and pricing of your pharmacy contract into our processing platform and runs the adjudicated claims against these parameters to reconcile any discrepancies. Findings are then presented to clients through Synergy Rx's reconciliation reporting suite and interactive online tools.

8. How do I recoup overcharges/mis-charges from the pharmacy based on your reports?
Synergy Rx provides you line by line details of the price discrepancies so you can request credits on your next bill. Additionally, we provide clients with line by line details on Split Bill opportunities, Return Eligible tracking, and Payor Source Discrepancies.

9. What other information do you need from clients for your reconciliation reports?
Assuming your pharmacy is adjudicating claims with Synergy Rx on a daily basis (we are also able to provide services using "batch" adjudication when absolutely necessary), we simply require a once monthly submission of a client's pharmacy bill and a specific set of facility census and payor information. Synergy can pull this information from many EHR's, and will assist clients with the collection of this information as a part of our onboarding process.

10. What is the cost of the Synergy Rx suite of services?
Synergy Rx services are provided in return for a low monthly fee per facility. Besides the significant financial savings of bill reconciliation through our adjudication system, this monthly fee can be meaningfully offset with certain revenues, effectively reducing your purchasing cost by maintaining compliance with your formulary.