Presentation Folder Inserts Test version 3-10-15

empowered oversight

Empowered Oversight

Cadre Healthcare Solutions was founded in 2012 to assist health plans with
oversight of their Part D bene ts. Our mission is to build intuitive software
tools that empower health plans with the ability to continuously oversee
their PBM and convert their data into meaningful information.

“Sponsors should perform regular and adequate oversight
of their PBM’s and other delegated entities to ensure that
they are complying with all CMS requirements.”

- CMS GUIDANCE MEMO [JANUARY 20, 2015]

PDE Reconciliation Pharmacy PBM Oversight

Using CMS guidance rule Oversight of your PBM can be How do you know if the data
sets, Cadre360® recreates the best way to lower risk you receive from your PBM is
your PDE’s from the original correct? Oversee and validate
and improve outcomes. Turn
Rx claims. your PBM data into veri ed the accuracy of your PBM.

actionable information.

Don’t Let Uncertainties Become Liabilities

Pharmacy Optimization

The ability to oversee how your PBM actions are a ecting your members is at the
heart of any successful MAPD or PDP plan. Cadre360 o ers the ability to quickly
and e ectively oversee a wide array of pharmacy services administered by your
PBM. With Cadre360® you will have real time oversight tools using veri ed data.
Give your team the ability to optimize your PBM’s per formance and identify
potential issues before they become problems.

“We strongly encourage plan sponsors to
utilize evaluation tools to proactively verify

that their organizations are compliant
with CMS requirements.”

- 2016 CMS Draft Call Letter

Cadre360® changes non-veri ed PBM data into veri ed information that's easy
to understand and use. Our unique user interface is optimized to provide pow-
erful access to your data so you can get quick answers to your questions and
spot trends before they become liabilities.

PBM Oversight

CMS has made it clear that the stakes have never been higher for the cost of non-
compliance. Failure to adequately provide oversight of your PBM is not only risky, it
also can be costly at a time when resources are diminishing. Improving oversight
management of your PBM can lower risks and improve outcomes.

“Sponsors must perform e ective oversight of First Tier Entities
delegated to perform critical Medicare operational functions,

especially PBM’s.”

- 2015 CMS Call Letter

FRAUD WASTE PDE
& ABUSE RECONCILIATION

PBM PHARMACY
OVERSIGHT OPTIMIZATION

PART D RX
BID EXPENDITURE

PDE Reconciliation

Are you sure that your PBM is submitting complete and accurate data to CMS
for your Medicare population (as required) and that you and your PBM are
adhering to all regulator y guidance. Your PBM’s gathers and repor ts your PDE
data but it is your responsibility to ensure compliance or face penalties.

“Protecting data integrity is a high priority for CMS. CMS’ current policy is to
reduce a contract’s measure rating to 1 star if it is identi ed that biased or

erroneous data has been submitted.”

- 2015 CMS Call Letter

ORIGINAL RX DATABASE CADRE PDE

CMS

RULES

To be able to make accurate decisions you must have accurate data. The best way
to make sure your data is accurate is to start with the basic building blocks - the
original Rx transactions. Using CMS guidance rules Cadre360® recreates each PDE,
one by one, from your original Rx claim.