With our robust clinical and specialty programs, we deliver value by driving positive health outcomes for your membership.
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.
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.
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.
A plan design parameter used to save the plan money on brand prescriptions when generic equivalents are available.
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.
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.
Allows prescribers to analyze an individual’s DNA to evaluate their ability to metabolize specific medications and select the most appropriate treatment option.
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.
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.