Savings With Independent
Clinical Review and Management
A Clinically-Based Approach to Prescription Drug Savings
US-Rx Care provides rigorous clinical evaluation from expert healthcare professionals specifically trained to analyze prescription claims for clinical appropriateness and identify more cost-effective alternatives when available. Our clinical review services deliver impressive-cost savings while maintaining the highest level of therapeutic impact. This program safeguards clinical decision-making from hidden, adverse profit incentives inherent in the traditional PBM model. For over 25 years, we’ve successfully reduced plan sponsor and enrollee pharmacy spend for:
Medical (J-code) prescription drugs
Comprehensive, Proprietary Prescription Optimization Process
US-Rx Care offers a unique enrollee advocacy program. Our proprietary systems monitor and analyze prescription claims to alert prescribers and enrollees when lower cost therapy options are available. Our advocates obtain new prescriptions from prescribers, educate enrollees on doctor approved alternatives, and assist in getting the new Rx to the pharmacy.
- Analyze Rx claims
- Identify savings opportunities
- Cost-saving recommendations sent to prescribers
Prescription For Approved Alternative
- Prescription obtained from provider
- 70% of all cases convert
- Members educated regarding prescriber-approved therapy changes
- Around 80% of the members approve the conversion
New Rx To Pharmacy
- Prescriptions for new medications are sent to pharmacy
- Pharmacy notified to cancel original prescription
Specialty & Medical (J Code) Drug Management
Specialty pharmaceuticals can cost tens or hundreds of thousands of dollars per year. No different from hospitalizations or high-cost diagnostic procedures, specialty pharmaceuticals require independent, objective clinical review and oversight to ensure coverage approval is supported by national guidelines and standards of care. US-Rx Care’s commitment to clinical rigor and fiduciary standards, ensures access to needed medication therapy, free of waste and overspending, always in the best interest of the plan and plan enrollees.
PA Request Received
Medical Necessity /Step Therapy Determination
Site of Care Management Process
Identify Alternate Site Options
Negotiate Price with Providers
Select Alternate Source
Your Single Source for Fiduciary Prescription Cost Management
US-Rx Care is the only provider in the pharmacy benefits industry proven to substantially reduce pharmacy spend through our fully integrated prescription drug savings programs. From start to finish, our program advocates for plan members through high-touch engagement with prescribers, pharmacies, and enrollees and we are fully fiduciary compliant.
Non-Specialty Prescription Management
Our Right Rx therapeutic optimization program identifies more affordable formulary alternatives for high-cost non-specialty medications. Our clinical algorithm houses over 1,500 cost-savings targets identifiable from pharmacy claims alone, saving plan sponsors $4-$8 per enrollee per month on average and reducing out-of-pocket cost of enrollees 30% or more on average.
Specialty Prescription Management
We deconflict the PBM relationship by taking on the prior authorization function for specialty medications. Our rigorous clinical review progress ensures each high-cost medication is medically necessary, appropriate, cost-effective, and conforms to national best practices of clinical care. Typical specialty pharmacy savings ranges from $8-$12 per enrollee per month.
Lowest Cost Sourcing
US-Rx Care does not own or operate a pharmacy, since that would introduce a conflict of interest. We always seek the lowest cost source for high-cost and specialty medications by leveraging manufacturer patient assistance and coupon programs, as well as alternative dispensing sources, to dramatically reduce plan and member spend.
Save a Combined
per enrollee per month with no change to benefit design
or greater savings in member out-of-pocket costs while increasing benefit value for your employees
Discover how much you could save by partnering with US-Rx Care for Clinical Services using this quick saving calculator.*
Mythbusting: Common Objections to Our Savings Solutions
MYTH 1 | Cost-saving benefits programs must be disruptive
We have successfully managed 5 million members enrolled under Medicare Part D and employer-sponsored plans without disruption for decades. By focusing our attention on the 6-10% of enrollees who generate 50-70% of total plan spend, our program remains invisible to the vast majority of plan members.
MYTH 2 | We have to change PBMs to realize the savings US-Rx Care can deliver
Our clinical management services work alongside existing PBM relationships to identify lower-cost, therapeutically-equivalent medications for each plan member’s unique medical needs. Through this partnership, enrollees typically spend 30% less on out-of-pocket costs.
MYTH 3 | We have to do what our broker or consultant tells us to do
Can your broker reduce your pharmacy benefits spending by 50%? If not, your vendor relationships may be hiding financial conflicts of interest. Our clinical services can supplement your current contract to locate therapeutic alternatives for necessary medications at the lowest possible cost.
Schedule a meeting today to discover how clinical services from US-Rx Care can save $15-$20 per member, per month with no change to benefit design.
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