Integrated Services Effectively Manage Your Drug Mix
Our core PBM services work together in our low net cost model to manage your pharmacy programs. We work with you as a partner to implement the best solutions for your unique member population.
- Proactive Account Management and Clinical Pharmacy Resources
- Strategic Benefit Plan Design
- Real-time Eligibility and Claims Management
- Pharmacy Network Management
- Data-driven Utilization Management
- Management Reporting and Decision-making Support
- Member Engagement and Education
- Quality Measurement and Monitoring
- Plan Sponsor Education
- Health Management Consulting
Proactive Account Management and Clinical Pharmacy Resources
Our multi-disciplinary approach to customer service means your account is staffed with professionals skilled in benefit design, pharmacy, operations and IT support. Your experienced account team will include an executive sponsor and a clinical pharmacist to monitor plan performance and make recommendations for measurable cost savings and clinical improvement.
Strategic Benefit Plan Design
Our flexible approach to plan design ensures you drive physicians, pharmacists and members toward the lowest net cost drug. We focus on using lowest cost generics and small drug molecules, in lieu of expensive biotech drugs, when medically appropriate. Our clinical team will analyze your utilization data to recommend the plan design that best aligns with your clinical and economic objectives.
Real-time Eligibility and Claims Management
Our Web-based eligibility and claims management system, MedAccess®, allows plan sponsors to do real-time prior authorizations, eligibility changes and direct member reimbursements.
Pharmacy Network Management
We work with you to develop the optimal channel management strategy for retail, mail-order and specialty dispensing. We adjudicate claims from all three dispensing channels so that you are able to manage the entire benefit and maximize savings. MedImpact introduced the 90-day supply of maintenance drugs at retail nearly 20 years ago, and we continue to promote pharmacy care continuity.
- Retail: Our national network of more than 60,000 credentialed retail pharmacies meets access requirements for commercial, Medicaid and Medicare Part D programs.
- Mail-order: We work with plan sponsors to select their mail vendor(s) of choice from our network of nearly 30 pharmacies to support effective management of maintenance drugs.
- Specialty: Choose from our five preferred specialty pharmacy vendors to manage specialty drugs according to your needs.
Data-driven Utilization Management
Our utilization management (UM) services use information technology tools and trained professionals to influence the behavior of patients, pharmacists and physicians. Based on your economic and clinical goals, we make data-driven recommendations on the best mix of UM services:
- Point-of-service System Edits
- Concurrent Drug Utilization Review
- Prior Authorization (MedResults®)
- Step Therapy
- Therapeutic Substitution
- Dose Optimization
- Multisource Brand Conversion
- Retrospective Drug Use Evaluation with Focus on Disease, Drug Safety and Patient Demographic
- Medication Therapy Management for Medicare Part D and Commercial Populations
Management Reporting and Decision-making Support
Our approach to management reporting includes consultative meetings and Web-based reporting tools. We support informed decision-making on a regular or ad hoc basis through:
- Self-service Management Reporting (MedOptimize®)
- Prior Authorization Utilization Value Reports
- Quarterly Comprehensive Graphical Reporting (MedFocus®)
- Accounting and financial Web-based reporting (MedImpact Online Reports)
Member Engagement and Education
We offer a customizable, online member portal with member-specific data on cost sharing amounts, formulary list and pharmacy locator. This real-time data can be supplemented by an online patient care management system that interfaces with health care providers, case managers and health coaches.
Quality Measurement and Monitoring
Our clinical analysis tools effectively support continuous quality improvement, NCQA, and other accreditation initiatives. We partner with you to identify and analyze treatment and drug therapy gaps using our Quality Performance Monitoring Program. Sophisticated reporting packages also address physician profiling and patient-level drug trends.
Plan Sponsor Education
Our clinical experts provide peer-reviewed drug, disease and therapeutic class monographs to inform you on emerging pharmacy trends and new drug products entering the market. Quarterly drug information publications include the Generic Drug Pipeline Report and Clinical Pipeline Report. Our MedImpact Connect® events for Hospitals, Medicaid and Medicare Part D Plan Sponsors provide business trend updates to enhance market opportunities.
Health Management Consulting
Our Health Services team of physicians, pharmacoeconomists and researchers provide strategies to improve patient population management. Using evidence-based approaches, our services include:
- Plan design modeling, including value-based benefit design approaches
- Predictive modeling of clinical intervention strategies
- Patient adherence strategies