Medicaid Pharmacy Benefits Services

Evidence-based pharmacy benefits services that help state Medicaid programs manage pharmacy claims, improve program finances, and support patient-centered care.
 

Manage Pharmacy Costs and Clinical Needs

Ease the management of pharmacy claims, removing the significant burden of processing and adjudicating these claims directly.

Streamline the prior authorization process and simplify one of the most complex steps in the pharmacy transactional chain.

Improve knowledge of drug lists and pipelines by leveraging the expertise of our dedicated pharmacy and clinical professionals.

Support patients’ clinical needs through informed care management and improving adherence to prescribed drug regimens for better clinical outcomes.

Maximize rebates while avoiding costs, enhancing the financial health of your Medicaid pharmacy programs.

Enhance Success in Medicaid Pharmacy Programs

Manage administrative challenges

  • Our company is dedicated to the pharmacy claims administration needs of state Medicaid plans, providing sophisticated electronic claims management for more than 20 years.
  • Our claims adjudication relieves a key administrative burden for state Medicaid plans by processing, adjudicating, and managing pharmacy claims in real time and at point-of-sale (POS).
  • Our sophisticated software and administrative capabilities are supported by hands-on account management. Our clinical resources are dedicated to the success of our state Medicaid plan customers.

Maximize plan financial health

  • We develop and maintain Preferred Drug Lists (PDLs) for each of our Medicaid plan customers. Unlike some other services in the marketplace, we tailor these lists to specific plan needs and provide full transparency into pharmacy pricing.
  • We leverage a comprehensive set of applications to manage administration, contracting, reporting, and distribution of rebates to participating state Medicaid plans.
  • We focus on maximizing returns to state Medicaid plans through drug rebates and cost avoidance opportunities through a variety of care management, patient support, and assessment programs.

Meet patients’ unique clinical needs

  • We facilitate the clinical review, approval, and processing of both pharmaceuticals and clinical/medical procedures covered by state Medicaid plans.
  • We utilize case management tools that facilitates the operation of complex care management programs for your members, addressing their unique clinical needs.
  • We provide oversight and support for state Medicaid plans to detect, recover, and prevent inappropriate payments, protecting against risks of financial losses and/or declines in healthcare quality.

Providing Measurable Value

$5B
Collected in rebates in 2017
1.5M+
help desk calls fielded in 2017
106M
claims transactions in 2017

Talk to Sales 1-866-873-3813

Get Started Online

All Fields Required
 

Existing Customers: Need Assistance?

You May Also Be Interested In

Pre-Payment Insight & Review

An analytics and methodology-driven prepayment medical record and claims review solution for payers that want to broadly view billing activity, identify improper payments before they are paid, and reduce waste in the payment process.

Audit & Recovery

A payment integrity solution for payers that want to maximize overpayment recovery, reduce improper payment waste, and promote provider satisfaction.

Coding Advisor

An analytics and sequenced process-driven claims adjustment solution for payers that want to identify billing outliers, change provider behavior, and reduce overpayments of low-dollar, high-volume claims.

Integrated Repricing Network

A solution for out of network claims that accesses 50+ national and regional PPO networks through a single interface, and uses routing optimization to achieve maximum savings.