Clinically Superior Formularies

Our team of pharmacists and nationally recognized physicians develop evidence-based formularies designed to maximize value while reducing costs.

  • RxSelect – evidence-based, broad formulary
  • RxCore – value-based, narrow formulary

Custom formularies are also available to employers.

 

Cost Saving Initiatives

We work hard to keep the cost of medications low. Here are just a few of the ways we’re working to save you money:

  • We have a 14-day first fill for oral oncology
  • We focus on eliminating high cost, low value-medications from our formularies
  • We’ve targeted diabetes costs by promoting lower-cost medication, preferred insulins, and preferred test strips
  • For compound medications, we’ve added cost restrictions and strategic tier placement

 

A Network with High Generic Use

Generics are an important way to lower the cost of prescription drugs. At 89-20%, our large employer generic dispensing rates are five to ten points better than the national average. Use our high-performing network—more than 45,000 pharmacies in all 50 states—or choose a custom network to leverage your internal pharmacies.

 

A Specialty Solution

Reduce specialty drug costs through our exclusive collaboration with Intermountain Specialty Pharmacy. When employees fill prescriptions for specialty drugs through this service, they receive advanced clinical support, and employers can save up to 2% on costs.

 

Drug Management Strategies that Work

Our team employs clinical programs to ensure proper utilization and cost.

  • Step therapy requires the use of a generic alternative prior to brand utilization and/or use of preferred products prior to the use of a non-preferred medication.
  • Preauthorization includes specific criteria, including diagnosis, age, and prior generic use, before a drug will be covered.
  • Concomitant therapy ensures members don’t receive duplicate therapy (i.e., members cannot obtain multiple sleep agents).
  • Poly pharmacy reviews claims for members who are high utilizers of prescription drugs to identify potential drug-drug interactions, duplication of therapy, and generic opportunities while providing education to members and providers about ways to decrease unnecessary utilization.
  • Narcotic management identifies over-utilizers and potential over-utilizers of narcotic medications. Once the member has been identified, they enter into a contract that restricts the coverage of their narcotic medication to one pharmacy and one physician.
  • Medication Therapy Management (MTM) detects members who have filled a high number of prescriptions each month (e.g., more than 18). Members and providers receive communications detailing cost-saving medication alternatives, drug-drug inter actions, and therapy duplications.