Clinical Consulting Resources

Formulary Management offers standard and customized Formulary solutions created by our Clinical staff and Pharmacy & Therapeutics (P&T) Committee.

Specialty Drug Management acts as a key component to managing increasing drug spend. PDMI manages and updates a specialty list for our clients weekly.

Clinical Advisory Services offers plan performance reviews and clinical benefit design reviews and consultations.

Custom Clinical Programs aid in decreasing plan costs and increasing patient care.

Concurrent Drug Utilization Review (DUR) offered in real-time uses a mix of NCPDP and Medi-Span modules to check for drug interactions while our proprietary algorithms can detect and prevent drug duplication.

Retrospective Drug Utilization Review can help identify cases with the potential to jeopardize a patient’s health and safety.

Polypharmacy Monitoring and Alerts are in place to identify patients at risk of taking an abundance of drug therapy, placing emphasis on those using duplicative therapy and medications to treat side effects of other drugs in their profile.

Fraud, Misuse and Abuse audit programs are designed to minimize the risk to the plan.

Compliance and Adherence Programs targeted at ensuring appropriate utilization for drug classes requiring strict patient compliance help ensure the best possible outcomes.

Drug Pipeline Monitoring offers close watch of brand and generic drugs to ensure that the impact of every new drug is clearly understood when it hits the market.

Coverage Authorizations including prior authorization, step therapy, quantity limitations and dose duration rules are constantly updated to ensure clinical appropriateness and effectiveness.