Client-Focused:
PerformRx was created as a direct result believing that there was a way to provide better Pharmacy Benefit Management services than what was being offered by other PBMs at that time. Those PBMs lacked the clinical focus to provide the necessary services to meet the challenges of supporting an Aged, Blind or Disabled (ABD) population. Being born from a health plan, PerformRx knows the issues faced by health plan payers. As such we offer unique expertise in pharmacy management to our clients. We understand that it is critical for a PBM to have a solid, outcome-driven, clinical focus to succeed. With this in mind, PerformRx has developed a variety of programs and services that have produced positive results for our clients' particular goals.
Managed Medicaid & Medicare Experience:
- We understand the complexity of managing under capitation within state limitations and scrutiny.
- PerformRx has over seven years of experience in managing Medicaid and Medicare populations including TANF and ABD with and without Medicare (dual eligibles).
- PerformRx currently manages pharmacy benefits for over 2 million Medicaid and Medicare members.
Behavioral Health Experience:
PerformRx's distinctive approach in behavioral health drug management for an ABD (dual eligible) population also differentiates us from other PBMs. Our extensive use and enforcement of POS edits, quantity limits, days supply, duplicate therapy, and other clinical edits have produced measurable positive outcomes both in the quality of care and financial results. It is the use of flexible leading-edge technology coupled with strong clinical staff and Medicaid experience that produces positive results.
Behavioral Health Results:
PerformRx has extensive experience dealing with behavioral health-specific medication issues. For example:
- PerformRx prepares and presents material for Behavioral Health Sub-committee meetings for several clients.
- We also maintain a network of independent consultant reviewers who are engaged to review policies and procedures related to Behavioral Health medications. When policies and/or practices are created or modified by our clinical staff, the policies benefit from the input of these experts.
Utilization Management Specialization:
- PerformRx offers behavioral health prescription drug management in risk and non-risk arrangements.
- PerformRx clients have experienced a year-to-year trend in pharmacy cost of less than 4 percent.
- While traditional PBMs focus on cost share/shifting of the drug cost, PerformRx focuses on Utilization Management (UM) designed for a Medicaid and Medicare population.
- Our claims processing system provides a variety of electronic, client-specific POS edits including maximum daily doses, step therapy protocols, quantity limits, duplicate therapy, and contraindication warnings that can be adapted to and maintained for a client to prevent inappropriate drug utilization.
- We offer 466 evidence-based and proven prior authorization protocols available to support clinical programs. Our web-based prior authorization system called PerformPA offers:
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466 prior authorization protocols (decision trees) that our clients can choose from, including:
- 403 for oral medications.
- 63 for injectable/specialty medications.
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466 prior authorization protocols (decision trees) that our clients can choose from, including:
- A menu-driven capability that allows you to design a client specific cost-containment strategy. Our protocols have supported cost savings of millions of dollars for our clients.
- Automation and customization to ease reporting work, reduce paperwork, and increase efficiency.
- Integrated pharmacy/nurse case management oversight for high-cost disease states; incorporating more sophisticated UM criteria using evidence-based clinical studies and guidelines.
- Outcome driven polypharmacy/point-of-sale intervention in collaboration with our contracted national network.
