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InformedRx commercial payer clients include
many of the leading organizations in the pharmaceutical
supply chain, such as health plans and managed care
organizations.
InformedRx provides a comprehensive suite of services to
support pharmacy benefit program in-sourcing needs on a per
transaction basis—providing the flexibility to select
services based on immediate business objectives, while
accommodating future needs. Simply stated, InformedRx
enables a client to be in control
of its pharmacy program.
InformedRx enables payer organizations to market and brand
their own pharmacy programs. Leveraging premier technology
and leading pharmacy benefit services, InformedRx payer
solutions are offered on an à la carte, fee-for-service
basis—with full price transparency and full disclosure—to
maximize your return on investment. This straightforward,
full pass-through model puts financial
control where it belongs, with the client, and offers the
opportunity to eliminate any misaligned incentives and
excessive revenue streams tied to drug spend with current vendor arrangement.
Clients can gain
increased control of their pharmacy benefit dollars and maximize cost control
and quality of care through a full range of pharmacy benefit
management services.
Electronic
Claims Adjudication: In 1991, we became one of the
first companies to bring to the market a claims processing
system designed for online, real-time adjudication of
prescription drug claims at the point-of-sale. Today, more
than one billion prescriptions are managed using this
state-of-the-art claims processing system. Unique in the
marketplace, InformedRx system solutions can be deployed as
a transaction-based processing capability, a licensed software
application, or a combination of both.
Pharmacy Network
Management: We offer a wide range of retail network
options, including supporting existing networks or assisting
clients in developing proprietary network that meets
specific geographic access requirements, desired price
discounts, or other service requirements. For Medicaid
populations, services can include a national Medicaid
network with Medicaid maximum allowable cost (MAC) pricing.
The InformedRx national retail network provides excellent
access at aggressive brand and MAC discounts on a full
pass-through basis. We do not retain undisclosed “spread”
revenue on dispensing fees and AWP percentages. The
InformedRx national network consists of more than 50,500
pharmacies in all 50 states and in Puerto Rico, Guam and
the Virgin Islands.
Drug Utilization
Review: InformedRx’s pre-dispensing DUR edit
checks are performed on an online, real-time basis between
mail and retail pharmacies. All prescriptions are checked for
participant eligibility and plan design features and are
then compared against previous histories of prescriptions
filled by the same pharmacy, by other participating retail
network pharmacies and by the mail service pharmacy.
Clinical
Services and Consulting: We welcome the opportunity
to contribute our consultative and technical expertise to
augment, develop, deploy and support any additional clinical
programs. Clients also have the option of using InformedRx’s
clinical programs, which incorporate complete prescription
drug information to reduce the growth rate of prescription
drug costs and increase the quality of care and patient
safety. InformedRx’s unique approach to managing the
prescription drug benefit goes beyond price and product and
focuses on utilization. InformedRx employs a comprehensive
clinical management strategy that addresses potential fraud
and abuse, compliance and utilization management, formulary
maximization and first-line generic maximization to drive
low net cost and the highest quality of care, with potential
ingredient cost savings. Our clinical
programs have sound, clinically supported criteria that are
structured to meet the regulatory standards of NCQA, as well
as those of state and federal agencies.
Formulary:
We can fully support a client's existing P&T Committee, existing formularies and
preferred drug lists or collaborate to create best-in-class
models supported by formulary predictive modeling and rebate
impact modeling and recommendations. Pharmacist-,
physician- and member-focused intervention protocols provide
cost and quality controls to drive generics, preferred drug
products and appropriate use. Clinically appropriate,
cost-savings opportunities are identified through proactive
management of drug therapeutic classes that contain brand
drug products expected to be reclassified as generic or
over-the-counter. The goal of InformedRx’s formulary is to
provide the highest quality pharmaceutical care at
the best value. As an independent (non-manufacturer
owned) provider, we have no hidden agendas relative to
promoting products to our clients. We can administer
formularies based on specific plan designs, or we can
provide clients with the tools to maintain their own custom
formularies online.
Rebate Administration:
All revenue received by InformedRx from pharmaceutical
manufacturers, related to clients’ pharmacy programs
(“rebates”), are disclosed to our clients. No games. InformedRx
will not profit at the expense of its clients. In addition,
we offer clients the ability to manage and track their own contractual arrangements through our
performance-based contract management system.
MAC Management:
InformedRx’s MAC list and pricing are designed to provide
adequate reimbursement to promote generic dispensing by the
pharmacy, while achieving competitive discounts and cost
controls on generically available drug products. InformedRx
can also develop and maintain a client-specific MAC list or
we can provide pricing and utilization support to maintain a
clients' own MAC list.
Enrollment and
Eligibility: Our system enables clients to perform
their
own eligibility updates online, real-time or on behalf of
their organization. We also can provide full eligibility
updates, or updates on an ad hoc or emergency basis.
Benefit
Plan Design and Management: InformedRx can
accommodate any plan design option required and can support
a virtually unlimited number of benefit design variations.
We also provide benefit design configuration support to our
clients in accordance with mutually developed processes.
Benefit designs can be modified online, in real time, by
InformedRx or client staff.
Reporting and Information Analysis Solutions: Two
main levels of reporting are available from InformedRx: our
standard reporting package (which includes a large menu of
unique reports), and our online analytical decision support
tool that is designed meet and exceed our clients'
expectations.
Mail
Services/Specialty Pharmacy: InformedRx maintains
preferred relationships with specialty/mail program
providers and can interface with any existing providers. Our
approach and philosophy are consistent with retail, mail
service and specialty providers. We do not maintain a
financial interest or receive revenue streams from these
areas. We can assist clients in contracting for these services
on an exclusive or open participation basis.
Call Center: InformedRx
has one primary call center for both member and pharmacy
calls. Our representatives are available to respond
to inquiries, such as prescription claim questions, benefit
plan details, and pharmacy locations. Members will find
comfort in knowing they can receive solid, reliable
information from an InformedRx pharmacist through a
convenient toll-free number.
Web Services: InformedRx
offers a suite of Web Services that enables clients to interact
with the claims processing system using a standardized
protocol in a secure environment. This method of
access provides clients with the freedom to build products,
tools and reports that utilize InformedRx data throughout
their enterprises. Once the raw data is in house, it
is the clients' to use as appropriate, thus providing far
greater flexibility and return on investment. Our member Web
site invites members to learn more about their prescription
benefit programs, medication histories, drug information and
related industry news. The member Web site can be
customized with a client's logo and name, links
to the organization’s Internet home site, and up-to-date
news bulletins about the organization.
Coordination of High-Utilizing Populations:
InformedRx supports clients in a variety of ways to
coordinate management of high-utilizing populations.
We will collaborate with our clients to define an integrated program
to support early identification of high-risk, high-utilizing
populations. Activities, including those listed below can be coordinated with a medical plan administrator’s large
case management process.
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Disease Management Candidate Identification
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Compliance Program Management
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Gaps in Care Program—Maintenance
Therapy Identification
Experience the Value of Control with InformedRx. |
