Pharmacy Benefit Management Service
PerformRx provides comprehensive pharmacy benefits management services for all payer types. Our programs include:
Pharmacy Network Administration
PerformRx clients have access to retail and specialty pharmacy providers throughout the country. Our network also includes mail service pharmacies for home delivery of maintenance medications.
We provide comprehensive network pharmacy contracting services, including:
- A pharmacy network to meet members' access needs.
- Nationwide pharmacy access through agreements with major chain pharmacies.
- Targeted solicitation of pharmacy network participation in designated service areas.
- A credentialing program designed to meet regulatory and contractual standards.
- Auditing services designed to detect and prevent fraud, and to reduce waste and overcharges.
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Medicare Part D Pharmacy Management
PerformRx supports MA-PD plans and other Part D programs with CMS-compliant pharmacy benefit management services. From claims adjudication to formulary support, pharmacy and therapeutics (P&T) committee collaboration, rebate management, medication therapy management service, and application support and reporting, PerformRx is prepared to fully assist in the management of this program component.
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Specialty Utilization Management
PerformRx, through its relationships with select specialty distribution pharmacies, will help you achieve appropriate utilization of these very expensive products at a competitive price. We offer an objective review program, which our clients find preferable to having the distributor reviewing its own utilization.
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Formulary Design
We will work with your P&T committee to maintain your formulary and suggest new or revised utilization protocols. We know that participation by a committee of members with various backgrounds and expertise ensures that decisions are from a clinical, humanistic, and pharmacoeconomic perspective. Along with our client's staff, PerformRx's staff members who are involved with updating prior authorization criteria protocols include pharmacists (Pharm.D.) with additional educational credentials, formulary managers, pharmacoeconomists, and outcomes researchers.
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Rebate Management
PerformRx provides rebate management services, including manufacturer contracting, for clients who desire control of their rebate program. This service provides full support, from contracting to reporting, and is open to audit. We can provide this service regardless of who is processing your pharmacy claims.
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Prior Authorization
PerformPA, our proprietary, web-based prior authorization program, is unique in the industry. Our services are differentiated by this prior authorization program, which provides a menu of 466 clinical protocols that are evidenced-based and supported with POS edits, including over 63 prior authorization protocols in our injectable programs alone. As such, we have been able to demonstrate savings in our current book of businesses compared to other PBMs.
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Call Center
PerformRx has a combined staff supporting both the Provider Call Center and the Member Service Call Center services. This approach allows members to speak directly with Certified Pharmacy Technicians who can provide members with a better understanding of drug classification, formulary, and are able to speak with pharmacists to retrieve verbal authorizations on the member's behalf. This advantage reduces call backs from members and providers.
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Mail Service
PerformRx's network of pharmacies includes mail-order pharmacies to allow for convenient home delivery of medications. Home delivery is ideal for the medicines that are prescribed for longer time periods, known as "maintenance medicines." PerformRx's network of mail order pharmacies includes Walgreens Mail Service and National Direct Home Pharmacy.
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Specialty Pharmacy
PerformRx is also different because we encourage and have the ability to manage specialty medications that are dispensed by physicians in their offices. Most specialty pharmacy services limit their utilization management to self-injectables. We can insure that prior authorization occurs for office-based injections, and we can adjudicate these claims through our claims processor. This creates total and complete utilization management of the specialty pharmacy program. A critical point of distinction is that we do not generate profit or revenue from distribution.
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In-Sourcing Transition Support
PerformRx provides all required services to support plans that desire to in-source some or all aspects of their pharmacy program.
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