Solutions that turn benefits into a
controllable system.
PBM economics, GLP-1 controls, stop-loss strategy, and governance—built on evidence trails, not vendor summaries.
If a recommendation can't be tied back to a claim line, contract term, or measurable KPI,
it's not strategy. It's theater.
PBM & Pharmacy Transparency
Pharmacy spend that can't be explained, reconciled, or defended.
What you get
A claim-level economic view of where margin can hide—spread, MAC behavior, specialty classification, network differentials, and fee definitions.
Typical deliverables
- PBM economics scorecard (measurable vs black box)
- NDC-level outlier flags + benchmark comparisons
- Rebate/fee definition map (what counts, what's excluded)
- Vendor accountability "ask list" (what to request next)
Data we use
Best: PBM contract + Rx claims detail + invoice reports
Minimum: Rx claims detail + summary reports
GLP-1 Strategy & Financial Control
GLP-1 trend that behaves like a runaway budget line without a control architecture.
What you get
Exposure modeling + practical levers (eligibility rules, re-auth checkpoints, escalation monitoring, discontinuation tracking) ranked by impact vs friction.
Typical deliverables
- GLP-1 spend drivers (new starts vs maintenance)
- Escalation curve + persistence/discontinuation signals
- 12-month PEPM impact forecast under scenarios
- Control options ranked by cost impact + member friction
Data we use
Best: Rx claims + eligibility + UM rules
Minimum: Rx claims + eligibility
Stop-Loss & Funding Architecture
Renewal sticker shock, volatility surprises, and funding decisions made without stress testing.
What you get
Capital-grade modeling that ties claims volatility to attachment strategy and renewal defense.
Typical deliverables
- Attachment point modeling + scenario testing
- Renewal forecasting + volatility stress tests
- Captive feasibility scan (when appropriate)
- Renewal defense narrative backed by evidence
Data we use
Best: Medical claims + stop-loss terms + enrollment
Minimum: Large claimant summaries + renewal terms
Broker Oversight & Compensation Forensics
Incentives you can't see—where "advice" can quietly reward higher costs.
What you get
Compensation tracing + conflict analysis that supports governance and vendor accountability.
Typical deliverables
- Compensation map (who got paid, how, and why it matters)
- Conflict risk narrative leadership can act on
- Oversight cadence (quarterly monitoring)
- Evidence pack for governance/board reporting
Data we use
Form 5500 (Schedule A/C when applicable) + broker agreements + disclosures
How Engagements Work
Productized for speed and clarity.
Spend Snapshot
(fast clarity)
High-signal review + prioritized "ask list."
Vendor / Contract + Claims Intake
(deeper truth)
Reconciliation, definitions, and economics model.
War Room Build
(ongoing operating system)
KPIs, reporting cadence, and decision levers.
Start with a snapshot or go straight to the War Room. jer@kincaidRMC.com
Want the fastest
clarity win?
Email jer@kincaidRMC.com or call 219.256.3331.