The PerformRx Difference
PerformRx specializes in providing Pharmacy Benefit Management (PBM) services for oral and specialty/injectable medications for customers in the Medicaid and Medicare health care sectors. Our philosophy is that utilization management should be handled internally, or by an independent third party, and should not be subcontracted to an entity responsible for distribution.
At PerformRx, our investment in our own Specialty Drug Program has led to significant per member per month (PMPM) reduction over the last few years despite rising prices and, in some cases, rising utilization. These reductions have been achieved by implementing the following:
- Competitive drug acquisition price negotiation
- Oversight of office-based injectable prescribing
- Specialty network management
- Dedicated specialty injectable staff
- Effective utilization management programs
- Inventory management at the patient level
- Detailed policies put in place to scrutinize billing
PerformRx, through our relationships with select specialty distribution pharmacies, helps health plans achieve appropriate utilization of these expensive products at a competitive price. The health plan avoids the inherent conflict of interest of having a PBM provide both distribution and utilization management services. We offer an objective review program, which our customers find preferable to having a distributor reviewing its own utilization.
PerformRx is different because we encourage and have the ability to manage specialty medications that are administered by physicians in their offices. Most specialty pharmacy services do not take utilization management this far, as they limit their focus to self-injectables. We can be sure that the prior authorization happens for office-based injections, by adjudicating these claims through our claims processor, and we replace the stock that is used or ship the medication in advance. This creates total and complete utilization management of the specialty drug program. A second and critical point of distinction is that we generate no profit or revenue from distribution. Our focus is on doing what is best for the health plan and its members.
