Frequently Asked Questions
What does managing the pharmacy benefit mean for the consumer?
Are you owned by a drug company, retail pharmacy or other corporation?
Do you offer access to your solutions via the Internet?
Do you offer Consumer Directed Health (CDH) programs?
How is it determined which drugs are included on the MedImpact Formulary?
Where is MedImpact located?
Corporate Headquarters:
MedImpact Healthcare Systems, Inc.
10680 Treena Street, Stop 5
San Diego, CA 92131
Phone: (858) 566-2727
Fax: (858) 621-5147
Email:
Click here for directions.
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What does MedImpact do?
MedImpact is a Pharmacy Benefits Management (PBM) company. Our focus is on managing the drug benefit for our clients and their members. As a PBM, we traditionally process pharmacy claims and provide clinical support to effectively manage the complexities of the drug benefit.
Currently serving more than 32 million members nationwide, MedImpact is the PBM for 8 of the top 10 HMOs in the country, as rated by Consumer Reports in 2009. MedImpact clients include corporations and employers, unions, managed care organizations, health plans, insurance carriers, and third-party administrators, as well as local, state and federal employee programs.
As a Medicare Part D participant, MedImpact acts as the PBM inside Prescription Drug Plans (PDP) as well as Medicare Advantage with Prescription Drug coverage (MA-PD) plans. MedImpact functions as the administrator for our Medicare Part D clients. We support various benefit designs including the standard drug benefit, the actuarial equivalent standard benefit, the basic alternative benefit, and the enhanced alternative benefit plans.
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What does managing the pharmacy benefit mean for the consumer?
When a consumer presents a prescription at a pharmacy, the pharmacist connects with the MedImpact computer system to determine eligibility, and perform over 800 clinical safety checks, such as potentially harmful medication interactions and restrictions. The pharmacy transaction is processed within seconds. Typically, once the prescription claim is approved, the pharmacist collects a copay or coinsurance from the patient. MedImpact then reimburses the pharmacy for the remainder and collects the amount owed from the patient's employer or health plan.
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Are you owned by a drug company, retail pharmacy or other corporation?
No. MedImpact is the largest PBM that does not sell drugs and does not own a fulfillment center, which means that we are not owned by drug manufacturers, drug wholesalers, or pharmacy chain drug stores. This independence gives us the freedom to develop our own programs – such as formularies, disease management, and rebate programs – based on objective, evaluations that of how industry alliances will produce optimal financial and therapeutic benefits for our clients. The MedImpact model and approach leads to better outcomes, lower net costs and higher quality of care for our clients and for the patients they serve.
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What is transparency?
To MedImpact, transparency is a philosophy, not a financial arrangement. MedImpact has embraced transparency since our inception in 1989, not because of litigation or regulation, but because we believe it is the right thing to do. It is the way we do business.
MedImpact is certified as transparent by the HR Policy Association’s Pharmaceutical Purchasing Coalition, as part of the Transparency in Pharmaceutical Purchasing Solutions (TIPPS) initiative. MedImpact fully discloses how and where our revenues come from to our clients. At MedImpact, we believe that clients have the right to know – both clinically and financially – what is going on with their drug benefit.
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Do you offer access to your solutions via the Internet?
Yes. Many of the MedImpact product and service offerings include web-based tools. With the powerful capabilities of the Internet, clients are empowered to quickly and efficiently access the latest MedImpact software versions through the Internet. Enhancements are effective on a real-time basis.
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Who are your clients?
Currently serving more than 32 million members nationwide, MedImpact is the PBM for 8 of the top 10 HMOs in the country, as rated by Consumer Reports in 2009. MedImpact clients include corporations and employers, unions, managed care organizations, health plans, insurance carriers, and third-party administrators, as well as local, state and federal employee programs.
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Do you offer Consumer Directed Health (CDH) programs?
Yes. MedImpact supports client Consumer Directed Health (CDH) initiatives as part of our commitment to delivering innovative choices. Our consumer directed tools include spending accounts, cash discount cards, a member Web site, a health management system, and integration with Microsoft® HealthVault™.
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How is it determined which drugs are included on the MedImpact Formulary?
Medications included on the MedCare® Formulary, MedImpact’s national formulary, have been reviewed by the MedImpact Pharmacy & Therapeutics (P&T) Committee, and have been found to be appropriate for inclusion on the basis of safety, efficacy, approved indications, ease of use, potential for adverse effects, and cost effectiveness. The P&T Committee consists of physicians, pharmacists, and clinicians representing a broad range of clinical practice and expertise internal and external to MedImpact, and meets quarterly to review and update the MedCare Formulary.