Your Single Source for Fiduciary Rx Cost Management
US-Rx Care is the only service provider in the industry today that has a proven track record of significantly reducing both specialty and non-specialty medication costs through our fully integrated Rx savings programs.
Over 80% Member Engagement
Over 90% Savings on 35% of Prior Authorizations
Non-Specialty Rx Management
(Reflects 50%-70% of Typical Plan Spend)
- Therapeutic optimization targeting high cost, non-specialty medications
- Save $4-$8 per plan enrollee per month on non-specialty medications.
How We Do It?
US-Rx Care goes far beyond traditional Pharmacy Benefit Administration programs to optimize use of preferred and cost-effective medications under your plan’s formulary.
Primary drivers of our unparalleled success include:
- Our breadth and depth of clinical algorithms including over 1,400 cost savings targets identifiable from pharmacy claims alone
- High touch engagement with both prescribers and plan enrollees to deliver the highest adoption rates of cost saving and quality improvement recommendations in the industry
- Experienced call center advocates maximize prescriber and member participation
- We are 4x-8x more effective than member-only directed programs
Advantages For Plan Enrollees:
- We do the work for plan participants/members so they don’t have to! Just informing them of cost savings options is not good enough…
- We contact their prescriber to identify the best, lower cost alternatives
- We educate the member regarding prescriber approved alternatives
- We make sure a new prescription gets to the member’s preferred pharmacy
- 30% average reduction in member out-of-pocket cost
- Prescriber and member friendly
Specialty Rx Management
(Reflects 30%-50% of Typical Plan Spend)
- Carve out your specialty pharmacy prior authorization process to US-Rx Care
- Save $6-$12 per plan enrollee per month on specialty pharmacy spend
How We Do It?
Deconflict your PBM relationship by having US-Rx Care perform the Prior Authorization function for specialty medications. If your PBM performs the prior authorization function for specialty pharmaceuticals and is also dispensing those same medications, the inherent conflict of interest is likely costing your plan money!
US-Rx Care has over 20 years of experience managing specialty pharmaceuticals for some of the nation’s largest health plans and self-insured employers. Our clients benefit from unbiased, expert review of every case, to ensure that any high cost medication is medically necessary, cost effective, and conforming with national guidelines and current standards of care.
Independent medical case management has existed for decades to oversee hospitalization and large case events for health plan sponsors. This ensures the entity profiting from care delivery is not also making medical necessity / appropriateness decisions.
US-Rx Care provides unbiased, independent, clinical management for high cost medications by decoupling PBM dispensing and rebate profits from the clinical prior authorization review.