Pharmacy Benefit Management

We are different from the rest.

We listen.

Listening is a lost art in our industry. At CerpassRx, we listen intently with the purpose of helping those we serve. We understand that by listening we are able to understand your goals as well as the needs of your members, thus in turn fulfilling our overall purpose.

We take good care of our members.

Focusing on your members is our way of life at CerpassRx. This is evident with our Member
Satisfaction Score: 4.7 out of 5.

4.7 out of 5

Member Satisfaction Score

For every 5 incoming calls our member services team makes 2 outbound calls.

White Glove Service

We take pride in providing white glove service through our extensive follow through, proactive outreaches and VIP program. For every 5 incoming calls, our member services team makes 2 outbound calls.

We partner with you to achieve your goals.

Whether your goals include saving money or enhancing your benefits, our team is here to assist you in meeting those goals. Your account management team will walk you through our robust reporting packages providing applicable commentary and creative solutions tailored to meet your needs. You can count on us to consistently evaluate your plan for opportunities to enhance your benefits and reach your objectives.

We drive positive health outcomes.

With our robust clinical and specialty programs, we deliver value by driving positive health outcomes for your membership.
PRIOR AUTHORIZATION
Ensures that select medications are administered as designed and that members receive therapy that is safe, effective for their condition and provides the greatest value.
QUANTITY LIMITS
A set of rules that sets quantity limits on the amount of drugs they cover over a certain period of time for safety and cost reasons.
HIGH DOLLAR LIMITS
A cost management strategy used to ensure any prescription exceeding a pre-defined dollar value receives an additional layer of clinical review before authorized.
DIABETES MANAGEMENT
Award-winning cellular blood glucose device with certified diabetic educators incorporated to provide monitoring and coaching.
ZERO COPAY PROGRAM
Health and wellness program designed to encourage utilization and adherence for select generic medications used to treat chronic conditions (diabetes, cardiovascular and high cholesterol).
COMPOUND MANAGEMENT TOOL KIT
Program which provides clients with a comprehensive and flexible management strategy containing multiple mechanisms used to help ensure the safety and cost effectiveness of compound medications.
NON-ESSENTIAL DRUG LIST
A cost management strategy which restricts the coverage of select high cost products which provide no additional therapeutic benefit compared to its alternatives.
DAW PENALTIES
A plan design parameter used to save the plan money on brand prescriptions when generic equivalents are available.
COPAY MODELING
An analysis that allows clients to evaluate the member impact and plan savings recognized if they elect to make adjustments to their current member cost share structure.
FORMULARY CHANGE
Our portfolio of standard formulary options allow clients to make elections which provide a full spectrum of drug coverage and plan savings opportunities.
NEW TO MARKET PROGRAM
Ensures all new products to the market are thoroughly evaluated for cost, safety, effectiveness and place in therapy before they are added to the formulary.
PHARMACOGENOMIC TESTING
Allows prescribers to analyze an individual’s DNA to evaluate their ability to metabolize specific medications and select the most appropriate treatment option.
IMMUNIZATION PROGRAM
Allows clients to coordinate an onsite administration of flu vaccines and reduce the impact of flu season.
PRODUCT/THERAPY CLASS EXCLUSIONS
Controls cost by eliminating coverage for a specific set of medications (cosmetic, weight loss, fertility, etc.)
MEDICATION ADHERENCE SOLUTION
Encourages members to remain compliant with the prescribed dosing regimen and frequency for medications associated with chronic conditions (diabetes, hypertension, hyperlipidemia).
PRESCRIPTION ALIGNMENT PROGRAM
Designed to improve medication adherence and increase member convenience by coordinating the fulfillment of qualifying maintenance medications to be picked up on the same day.
PRICE INFLATION PROTECTION PROGRAM
Aids in monitoring and controlling the AWP price inflation for existing products. All products with therapeutic alternatives which encounter a significant price inflation will be excluded.
CHANNEL OPTIMIZATION
Designed to direct prescription claims to a preferred pharmacy by encouraging in-house utilization or a specific distribution channel, such as mail order or specialty.
PROACTIVE PRIOR AUTHORIZATION PROGRAM
Designed to eliminate member and pharmacy disruption by reaching out proactively to the physician prior to expiration of select clinical prior authorizations
SPECIALTY CARE MANAGEMENT
Uses a trained clinical care team of physicians, pharmacists and nurses to improve prescribing and compliance which results in better prescription decisions, less waste and improved medication adherence among specialty utilizers.
WEIGHT LOSS SOLUTION
Designed to help members lose weight and reduce the risk of developing diseases like diabetes and cardiovascular disease.

We empower you.

Because we foster partnerships and empowerment, we provide clients with access to our claims adjudication system and members convenient access to their prescription benefits and history through the CerpassRx web portal or mobile app. We’ve found that providing this access to our clients and members alike, empowers them to be more efficient and make wiser choices.

Want to learn more?

Ready to meet a collaborative, accountable, flexible, responsive and reliable PBM? Let us show you what we can accomplish together through true partnership. Contact us to learn more.