INNOVATIVE APPROACH

Our primary function is to process and pay prescription drug claims. Our system is cutting edge and gives real time claims adjudication capability and allows us to gain the analytics and reporting we use to help in cost containment of drug spend for our clients.

We are on the forefront of the Part D curve and approach servicing our clients with a compliance first perspective. As a partner and an expert advisor, we provide the important information and advisory services to maximize your benefits. We help to improve your drug spend trend, increase STAR ratings, provide CMS Audit support and better your Generic Dispensing Rate.

We provide a single point of contact with complete understanding of the client’s goals and objectives. By leveraging subject matter experts for additional support, we achieve complete issue resolution in a timely manner.

We have a 24 hour a day, 7 days a week, 365 days a year call center staffed by a team of Pharmacists and Certified Pharmacy Technicians. By using intuitive informative communication tools tailored to specific preferences, we encourage smarter prescription medication choices and achieve the lowest net cost by delivering these communications in a manner that is most convenient for members.

Our Pharmacist Call Center staff provides support to pharmacists and other providers regarding questions about the pharmacy network and submission of claims, to include assistance with DUR claims messaging, formulary, and prior authorizations. Our goal is same day issue resolution.

We help identify errors and issues in the administration of your plan, bringing immediate corrective action and help provide reimbursement, verifying pricing, rebating and fraud, waste and abuse. Using customizable reporting to aid in identifying trends, we help our clients understand and make adjustment in order to improve their return on investment and improve clinical outcomes.

We customize the benefit design to the unique needs of our clients, allowing the desired amount of control. We know that the optimal way to provide the greatest health state for the member, while concentrating on providing a cost effective therapy that reduce the cost to our clients is in the Management of the plan design..

We help in defining the core facets such as which products will be covered or not, which medications need prior authorization, medication quantity limits, tools to encourage members to utilize lower cost alternatives through a tiered copayment structure will empower our clients to make an informed decision on design that fits their own needs.

We will actively promote limited pharmacy networks to leverage market share and improve discounts keeping member access in mind. We don’t own a retail pharmacy so we focus on obtaining the deepest possible discount to clients.

We provide timely, streamlined rebate administration services. We believe the key to effective rebate administration is aligning your interest, having honest, and open dialogue on all negotiations. Our proprietary technology calculates rebates at the claim level.

With the increase in prescribing and cost, our main focus is on the utilization management verses the distribution of these medication therapies. Our emphasis is on the outcome of these therapies and managing unit costs by avoiding waste and inappropriate utilization.

We offer a voluntary, convenient home delivery service of medication with greater discount on brand and generic medications, ideal for maintenance medications with lower co-pays for members.