Clinical Pharmacy Services

Payers offering a drug benefit need to provide positive patient outcomes while simultaneously controlling drug costs. Our clinical pharmacy team’s innovative approach ensures that plans are providing services appropriately and effectively while also maximizing pharmacy benefit access for members.

What Challenges You

To make sound clinical and financial decisions for their members’ care, Medicaid agencies and health insurers need critical analysis and pharmacy intelligence, layered with clinical and operational excellence. Your organization may struggle with trying to ensure optimal care and treatment as it balances escalating drug costs. At the same time, in the pharmacy benefit industry, there has been limited transparency between state agencies and insurers, and their pharmacy benefit management vendors.

Why Choose Us

Our highly experienced, multidisciplinary team—including pharmacists, pharmacy technicians, physician advisors, and data and research professionals—understands today’s fast-changing healthcare environment. We understand payers’ and providers’ need to continually assess and improve prescribing and coverage practices. We offer innovative options to help you achieve the highest-quality patient outcomes while ensuring the cost-effectiveness of your pharmacy benefit programs, even as expenses rise and budgets tighten.

How We Can Help

  1. 1

    We are an independent partner—not incentivized by rebate or price volume—providing clinical and operational expertise to enhance your decision-making and overall performance.
  2. 2

    We bring 20+ years of experience to our understanding of payers' and providers' need to continually assess and improve prescribing and coverage practices.
  3. 3

    Our formulary management, prior authorization, and step therapy initiatives help Medicaid programs avoid millions of dollars in costs.

Our Impact

Maximizing pharmacy benefit access and outcomes, controlling costs

Focusing on the best outcomes for members and through less costly drug initiatives such as step therapy, formulary management, and prior authorization, and our team delivers an annual cost avoidance of more than $250M for one Medicaid client.

For a Medicaid Hepatitis C Vaccine Program, we oversaw a $10 return on investment in avoided medication spending for each $1 spent.

To date, we have assisted one client on seven value-based contracts negotiated directly with drug manufacturers—where payment is made based on the value threshold being reached—yielding over $120M in savings during the first year.