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.

WellManaged Diabetes

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

WellManaged Respiratory

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

WellManaged Opioids

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

WellManaged Generics

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

Preferred Brands

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

Prior Authorization

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

Quantity Limits

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

Retrospective Drug Utilization Review

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

Compound Management

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

New to Market

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

Hyperinflationary Drugs

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