Independent clinical management for the health of your plan and your members
Protect the health of your while saving on pharmacy benefits
You want to be able to offer your employees the most robust pharmacy benefits you can afford, ensuring they get the medications they need – without breaking your benefits budget. Clinical expertise, management, and intervention are key to making that possible. The RxBenefits Protect suite of clinical solutions is designed and led by our team of independent PharmDs to ensure those medications are appropriately prescribed, clinically effective, and cost-efficient.
Additional 7-10% Savings
average savings in the first year
Low Clinical Value (LCV) Formulary Exclusions
If you’re getting a great price on the wrong drug, are you really saving money? Low Clinical Value Formulary Exclusions identify and remove high-cost drugs from the PBM formularies when more affordable, equally effective alternatives are available. Your members will still be able to access the treatments they need, while you’ll be protected against unnecessary spending.
Independent Prior Authorizations
Foundational Prior Authorizations
Our independent team manually reviews all prior authorizations, checking claims against chart notes to ensure prescriptions are clinically and financially sound.
High Dollar Claim Review
Our PharmDs review particularly high-cost (more than $1,000 for a 30-day supply) non-specialty medications to ensure they’re medically necessary and prescribed according to FDA guidelines and clinical best practices.
Complex Condition Intervention (CCI)
Members taking very expensive specialty medications for serious, complex, or chronic conditions deserve next-level protection. Our PharmDs engage a condition specialist – an MD – for CCI reviews to ensure your member is receiving the right drug, at the right dosage, at the right price.
Utilization Management for Next Generation Diabetes Drugs
High-Touch Therapeutic Interchange for Anti-Inflammatory Medications and Dermatologic Agents
New as of June 2024
The top two drivers of specialty drug spending are anti-inflammatory medications and dermatologic agents. This program proactively identifies members who are taking those classes of medications and are most likely to benefit from intervention. Our expert specialty pharmacists reach out to the member’s prescriber to determine if a more affordable, equally effective alternative treatment is available. If it is, the member still receives the medication they need, but at a lower price. Then our clinical pharmacist monitors your member’s care over time to ensure they’re continuing to benefit from the treatment.
Clinical management is crucial for safety and savings.
Talk to your employee benefit advisor about protecting your plan and your members with RxBenefits Protect.
