Clinical Guidance

Solid Benefit Guidance (SBG) delivers independent and non-biased third party clinical and strategic assessments.

We will make sure your pharmacy program not only works in concert with your formulary and utilization management programs to deliver market competitive benefits, but also avoids unnecessary costs – now and in the future.

The team of pharmacists at Solid Benefit Guidance has extensive industry experience in driving best practices, medication value, optimizing outcomes and minimizing costs/reducing trends.

We offer Pharmacy Clinical Consultation Services in both the Managed Care and Employer Group (Commercial Market) sectors of the healthcare industry. Whether you are a Managed Care plan serving the needs of a Commercial, Medicare, Medicaid and Exchange population, or you are a Plan Sponsor focused on actively managing your Pharmacy program, we have an array of world class clinical resources at your disposal.

Clinical Consultation and Guidance Services offered by Solid Benefit Guidance include:

Program Evaluation and Strategy Support for Managed Care Organizations

Our service offerings include:

Formulary and Utilization Management Programs

We work with clients who have in-house formulary management programs to evolve and deliver practical, best-in-class medication evaluations and formulary/utilization management programs across the medical and prescription benefits.

Our methods emphasize objective, independent assessments that determine the comparative value across options and predict the performance of medications.

Specialty Pharmacy

Pharmacy & Therapeutic Committees

We assist clients in:

  • Structuring P & T Committees to serve as stewards of health care resources
  • Applying best practices in decisions making
  • Ensuring only high value medications are included on the formulary and/or are in a preferred status

Coverage Criteria

We can aid in the development of sound coverage criteria including:

  • Prior authorization criteria
  • Step edits
  • Quantity level limits
  • Reasonableness edits

Our approach results in solid, practical coverage criteria that reduce trends.

Medication Therapy Management (MTM) Programs

Solid Benefit Guidance is an industry leader in procuring and assessing MTM services for all lines of business.

MTM programs are still evolving and increasing in competitiveness. Offerings between service providers differ in structure, process, interventions, results, and cost.

Our in-depth expertise will ensure you are matched with an MTM provider based on your requirements, needs, and outcomes targets.

We will make sure your MTM service provider:

  • Meets CMS requirements (this encompasses comprehensive contractual and performance guarantee backing)
  • Provides high quality services and drives favorable, measurable health outcomes
  • Delivers comprehensive, transparent reporting
  • Provides services at competitive administrative rates

Pharmacy Program Effectiveness and Opportunities

We provide independent evaluations of the effectiveness, results, and opportunities of pharmacy programs. These include:

  • Assessing impact on health outcomes
  • Evaluating financial performance and validating return-on-investment (ROI)
  • Benchmarking with industry results and best practices
  • Identifying cost avoidance opportunities

We will provide recommendations and solutions for further improving performance and results.

Customized Clinical Consultation Services for Managed Care Plans and Employer Groups

Benefit Designs

We can help ensure that your benefit designs are:

  • Market competitive
  • Driving value and the best health care outcomes while avoiding unnecessary costs
  • Positioned for the growth of specialty pharmaceuticals and the introduction of bio-similars

Formulary and Utilization Program Selection

We will:

  • Help select which formularies and Utilization Management programs best fit your goals and needs
  • Develop customized formulary strategies to best meet the needs of your unique population
  • Guide you through considerations in selecting standard programs versus choosing to customize

Interpretation of Utilization Management Results

It is important for you to understand your true total costs and trends. Medication claims reporting is complex and technical expertise is necessary to accurately interpret results.

We deliver comprehensive independent third party evaluations of your utilization management reports and results, so that you have high confidence in understanding the results and your total costs and trends now and in the future.

Trends and Future Costs

We take into account the dynamics and pipeline of the pharmaceutical industry, especially the growth of specialty medications, in helping clients be prepared for managing future costs.

Specialty Pharmacy


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