PBM Components: Robust Clinical Programs
informedRx includes comprehensive patient care management programs designed to reduce both pharmacy and medical cost. Our robust suite of clinical program ties your pharmacy data with our advanced predictive modeling tool to identify your high cost members before they incur significant costs. Our clinical approach spans a continuum of interventions using advanced analytics to target the right plan members, intervene at the right time in a meaningful way and help prescribers and members make informed treatment decisions.
Reaching the right patients and prescribers with timely, relevant and actionable guidance results in better patient outcomes. Better patient outcomes drive down avoidable medical costs. We use sophisticated technology, prescription data analysis and dedicated clinical staff to deploy strategies which:
- Help reduce undesirable events, increase medication compliance, decrease medication waste and promote plan member well-being
- Identify members for targeted intervention based on lack of adherence to evidence-based care guidelines, non-compliance with prescribed medication regimens and indications that medication dosing regimens are not safe or optimal for the patient
- Optimize and complement existing disease and case management programs when applicable
Clinical management programs are customized based on insights from client data and include:
- Prior Authorization
- Step Therapy Program
- Quantity Limits Program
- Guideline Compliance Program
- Dose Optimization Program
- Medication Compliance Program
- Generic Substitution Program
- Drug-drug Interactions
- Retrospective DUR Programs
- Medication Therapy Management Program
- Controlled Drug Program
- Formulary Compliance Program
- High-risk Medication Measures
- Therapeutic Duplication Program
- Therapeutic Interchange Program
- Physician Profiling
- Retail Network
- Mail Service
- Specialty Pharmacy
- Clinical Programs