Pharmacy Benefit Management (PBM) Services

SXC provides a broad range of pharmacy spend management solutions and information technology capabilities.

Our product offerings and solutions combine a wide range of PBM software applications, application service provider (ASP) processing services, and professional services designed for many of the largest organizations in the pharmaceutical supply chain, such as pharmacy benefit managers, managed care organizations, self-insured employer groups, retail pharmacy chains, and state and federal government entities.

Our clients have gained increased control of their pharmacy benefit dollars and maximized cost control and quality of care through a full range of pharmacy spend management services, including:

Formulary Administration — We can fully support our clients’ existing formularies and preferred drug lists or collaborate to create best-in-class models supported by formulary predictive modeling and impact analysis. Pharmacist, physician and member-focused intervention protocols provide quality controls to drive generics, preferred drug products and appropriate use. 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.

Benefit Plan Design and Management — We will accommodate any plan design option required and will support an 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 SXC or by the client’s staff.

Pharmacy Network Management — We offer a wide range of retail network options, including supporting existing networks or assisting clients in developing proprietary networks that meet 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. Our national retail network—which consists of more than 56,000 pharmacies in all 50 states and in Puerto Rico, Guam and the Virgin Islands—provides excellent access to our clients.

Drug Utilization Review — 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 — SXC contributes our consultative and technical expertise to augment, develop, deploy and support any additional clinical programs. Clients also have the option of using our clinical programs, which incorporate complete prescription drug information to reduce the growth rate of prescription drug costs and increase the quality of care and member safety. Our unique approach to managing the prescription drug benefit goes beyond price and product and focuses on utilization. We obtain a comprehensive clinical management strategy that addresses potential fraud and abuse, compliance and utilization management, to drive 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.

Reporting and Information Analysis Solutions — We provide two main levels of reporting—our standard reporting package (which includes a large menu of unique reports), and our online analytical decision support tool, RxTRACK^®, designed meet and exceed our clients' expectations.

Specialty Pharmacy Solutions — Established in 1994, SXC Ascend SpecialtyRx (formerly Portland Professional Pharmacy) offers more than 100 years of combined pharmacy experience in our staff of Doctors of Pharmacy, clinical pharmacists and specially trained registered nurses. Ascend’s unique pharmacy care and specialty medication therapy management programs have made us a recognized leader in pharmacy services and patient care.

Ascend serves patients who require specialty pharmaceuticals, injectable medications and complex treatment regimens. Our pharmacy specializes in the safe, effective administration and home delivery of these drugs, while offering the highest levels of compassionate, personalized patient care. SXC Ascend’s clinical expertise and specialty therapy medication management programs help patients maximize their treatment options and improve their quality of life and medical outcomes.

informedMail — Our full-service, state-of-the-art home delivery pharmacy offers an easy, cost-effective and convenient way for members to fill prescriptions for maintenance medications.

For plan sponsors, home delivery is an important element of an overall strategy for improving patient care and controlling plan costs. An effective home delivery program can save plan sponsors as much as 20% on their pharmacy benefit spend.

When integrated with other PBM services from informedMail, home delivery can increase compliance, the use of generics and adherence to formulary structures. It can also help prevent health complications through the use of DUR edits that notify mail facility pharmacists about specific patient conditions or plan parameters. Integration of mail with other services means that all relevant patient and plan information can be accessed through a single system. Therefore plan features such as prior authorization guidelines, refill too soon or drug interaction alerts can be applied to mail service claims. This tight integration maximizes the opportunity for cost savings and improves health outcomes for members.

Web Services—We offer 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 SXC data throughout their enterprises. Once the raw data is in house, it can be used by the client as appropriate, thus providing far greater flexibility and return on investment. Our member Web site, RxPORTAL^™, invites members to learn more about their prescription benefit programs, medication histories, drug information and related industry news. This 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.