Clinical Programs

Our clinical programs focus on patient and physician engagement to improve health outcomes and control costs. We promote use of first-line therapies and ensure prescribed medications are clinically appropriate and provide maximum value for members.

Includes patient education and engagement focused on diabetes prevention, early diagnosis and appropriate treatment.

Helps patients better control their asthma and COPD, improve adherence of controller medications and reduce need for emergency care and hospitalization.

Prioritizes patient safety and cost management while maintaining access to medications to control pain.

Promotes use of preferred generics over higher cost generics or higher cost brands.

Focuses on driving utilization of safe and effective treatment options that are clinically proven and cost-effective products.

Ensures the right drug at the best price is prescribed for the patient with a clinical review prior to coverage authorizations.

Confirms prescribed quantities are compliant with clinical guidelines, ensures appropriate utilization and avoids potential waste, misuse or abuse of medications.

Alerts providers to potential issues such as multiple prescribers, multiple pharmacies, or duplicate therapies.

Evaluates compound drug claims using a comprehensive list of excluded compound ingredients, bulk chemicals and kits that are hyper-inflated.

Protects clients against high-cost new drugs by blocking new medication for six months, enabling a thorough review and appropriate formulary placement.

Offers protection against inflationary drugs by limiting coverage or excluding them.