The Power of a Complete Solution
Our PBM solution includes a robust network and out-of-network clinical review capability that is unrivaled in the industry. As much as 39% of pharmacy spend comes from out-of-network sources and is traditionally unmanaged by PBMs resulting in higher costs. By bringing together both in and out-of-network prescriptions into a comprehensive PBM solution, we provide a holistic and complete clinical solution to address all your pharmacy expenses and better manage overall claim performance. Whereas traditional PBMs are only able to provide clinical review on claims submitted through network pharmacies, we are the only PBM solution that provides the same clinical oversight to both in and out-of-network scripts through our patented technology.
We offer the most accurate clinical risk assessment giving your claims professionals the opportunity to make the most informed decisions. In fact, 1 in 5 claims have an inaccurate clinical risk assessment with traditional PBMs considering only network submitted pharmacy scripts. Our ability to look at all prescriptions provides customers with a complete view of the patients care and the most accurate clinical risk assessment possible to make critical claims decisions.
Features and Benefits
- Clinical oversight on all prescriptions
- Increased savings through patented out-of-network solution
- Holistic view of PBM, bill review, clinical, and claims system data
- Ability to influence provider dispensing behavior through network relationships
- Real-time smart routing to adjusters, pharmacists, and case managers to ensure the right claim is handled by the right resource at the right time
- Risk scoring to flag high-risk, high dollar cases
- In-depth reporting specific to your program
- Early intervention programs
- Actionable insight tools for decision support
Integration Provides Double Digit Savings
“Having the bill review and ScriptAdvisor programs integrated significantly improves ease of use”
—VP of Claim Operations, Regional WC Carrier
The Industry's Most Complete Pharmacy Solution
Industry Leading Pharmacy Expertise
We know every client faces unique business challenges. You require a partner that understands the needs of your claim population to achieve the best outcomes while keeping overall costs down. Our experienced PBM team empowers you with the right tools including in-depth reporting, tailored clinical insights, actionable recommendations, and unparalleled integration to build a program designed exclusively for you.
Connecting Clinical Insights
Our experienced team of dedicated workers’ compensation and auto pharmacists deliver a comprehensive clinical program that employs point-of-sale controls and clinical management from first fill to claim closure. Our flexible solution allows you to customize your program down to the individual drug list and manage how we communicate with your team.
We feature cutting-edge risk management and monitoring programs that connect your team to comprehensive end-to-end clinical insights and smart decision-making recommendations to keep your claims population on the road to recovery.
Our clinical team helped one Utah client decrease opioid prescribing by more than 50%.
Dedicated Compliance Team
Workers’ comp and auto compliance is complex and constantly changing. When laws are changing at rapid speed, you need a business partner that will ensure you are prepared.
Our nationally recognized policy experts spend extensive time with state legislators and regulators to fully understand new regulations and help our clients understand and implement any changes through regular updates, timely alerts, and personalized consulting.