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Clinical Services and Support - RxAmerica understands the unique clinical needs of our customers. Our staff of experienced clinical pharmacists provides plan analysis and recommendations while ensuring overall cost-containment for our customers.

RxAmerica’s Clinical Services Department provides the following services:

Utilization & Management

1. Serve as a resource for information on new drugs, new technologies, standards of practice and industry trends. Provide analysis of the potential impact of these on the pharmacy budget and, when appropriate, strategies to balance the impact.
2. Assist in the design and implementation of programs to improve our customers’ utilization of cost-effective preferred products.
3. Review the reporting package with our customers to make sure the reports are meeting their needs.
4. Participate in the maintenance of our customers’ drug formulary.

Retrospective DUR (RxReview)

RxAmerica utilizes a variety of retrospective drug utilization tools to identify patterns of utilization that may have a negative impact upon your plan. We offer a variety of consultative services to meet a variety of customer needs. These range from simply producing reports to the preparation of semi-annual plan reviews(RxReview). Depending upon the customer’s needs, the review may include comparison of key utilization parameters to similar RxAmerica customers and specific recommendations based on specific plan data. Typically, these focus on specific drugs or therapeutic drug categories. Additional tools include identifying patients, physicians or pharmacies that may be contributing to unusual utilization patterns. We can also facilitate a high level review of the pharmacy program as it integrates with your utilization management, marketing, customer service, and provider service departments.

Formulary Management

RxAmerica offers our own clinically based formulary, RxFormulary, that has been in use since October 1, 1994. The philosophy behind RxAmerica’s formulary is to provide cost effective therapy without compromising the quality of patient care. Formulary decisions are made by an independent Pharmacy and Therapeutics Advisory Panel. Factors involved in formulary decisions include:

• drug safety
• drug efficacy
• compliance issues
• monitoring costs
• acquisition cost

The formulary is reviewed quarterly and revised to incorporate new developments in pharmaceutical care.

RxAmerica has the ability to manage several styles of formulary drug programs. The selection of one of these options, or the design of additional options is available to our customers.

Open Formulary: (No restriction on which drugs can be used.)

RxAmerica's Open Formulary plans allow the patient to receive any FDA approved products. The Open Formulary may contain prescription drugs subject to specific plan exclusions.

Modified Formulary: (Some limitations on what drugs can be used, or a penalty if used and not in the formulary.)

The Preferred Incentive Plans allows the patient to receive non-preferred drug products, but may require that the member pay a significantly higher co-payment, such as 50% of the approved cost. This can be a particularly attractive plan for those customers who do not wish to fully restrict non-preferred drugs, yet wish to influence prescribing trends. It allows choice, but for a price.

Closed Formulary: (Only drugs in the formulary are approved for use and covered by the plan.)

The Closed Formulary offers the tightest controls and greatest cost savings. Closed formulary programs provide the optimum plan control and may receive higher rebate compensation. Rebate compensation varies due to formulary composition (e.g., generic based formularies result in lower rebates, but have the lowest costs). Closed formularies require the highest patient, physician and pharmacy education. Patient satisfaction with plan benefits is a potential down-side to closed formulary plans.