Clinical Services

Comprehensive Clinical Services
Understanding and implementing an appropriate cost-sharing strategy is the key to controlling your drug spend. We provide clients with a team of clinicians to assist in the development of a clinical program that fits the needs of your unique membership. The structure of your prescription benefit plan is the cornerstone of the many cost management programs to be considered. With ProCare Rx, you will save with the following programs:

  • Lowest Cost Formulary
  • Prior authorization of high cost specialty medications
  • Step therapy and quantity limits
  • Therapeutic interchange
  • Generic drug initiatives
  • OTC switch programs

 

Formulary Programs
ProCare Rx’s National Formulary is an open 3 tier formulary that can be customized for your specific needs, including changing of tiers for drugs, addition of more tiers, inclusion of OTCs, variable specialty tier, etc. Our formulary contains medications that our own clinicians feel will deliver the best clinical outcomes for your members, while delivering you the lowest costs. Changes to our formulary are provided to you through quarterly newsletters and monthly Rx news reviews.

Other formulary driven programs include:

  • Client-specific custom formulary development
  • Pocket formulary program
  • Therapeutic MAC program
  • OTC Cap program

 

We take great pride in the performance of our clinically driven and financially supported formulary and our “lowest net cost of therapy” philosophy. We only charge for NET PAID CLAIMS (paid claims are +1, reversed claims are -1, and rejects are 0).  We negate the entire Rx for reversals, not just the ingredient cost.  ProCare Rx gives you many other ways to save with Therapeutic Interchange, Generic Drug Initiatives, and OTC Switch Programs. Clients using our formulary have maintained cost trends below national growth rates for the last ten years.

Featured Items

URAC Certification URAC Certification
PBM Services Provided by ProCare PBM Mail Order Provided by ProCare PharmacyCare