A female pharmacist sits with a senior female patient in the pharmacist consultation area and discusses her prescription and choice of medication. In the background a father and daughter stand at the dispensing counter and are served by a female pharmacy assistant .

Independent clinical oversight 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, oversight, 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.

Pills spilled on top of money

Additional 7-10% Savings
average savings in the first year

Rayos is a delayed-release version of Prednisone that costs roughly 280x as much as regular Prednisone

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 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.

2022 Total Gross Cost

Clinical oversight is crucial for safety and savings.

Talk to your employee benefit advisor about protecting your plan and your members with RxBenefits Protect.