Commercial Health Plans, Employers, Managed-Medicaid

At Magellan Rx Management, we know health plans and employers. With Magellan Rx, customers can feel assured of their members’ satisfaction as we work hard to limit member disruption, focus on optimum savings, and provide unparalleled formulary management strategies. We are eager to roll up our sleeves and lean into the complex formulary challenges impacting commercial health plans and employer groups.


MRx National P&T Committee

We have separate committees responsible for the clinical versus the financial analyses. Our drug review process is thorough and compliant with URAC, NCQA, and CMS standards.

Committees:

clinical committee | magellan rx management

Clinical Committee

Our clinical committee provides expertise on pharmaceutical products based on a rigorous drug evaluation process that involves a review of FDA-approved labeling, peer-reviewed literature, and treatment guidelines.

Financial Committee | Magellan RxFinancial Committee

Our financial committee considers the value of drugs through an evaluation of cost effectiveness, market share, and drug utilization trends among clinically similar medications.


Formulary Options

Our committees continually monitor the pharmaceutical landscape to manage formularies that ensure our members will have access to clinically appropriate medications while providing our customers with optimal financial value and savings. Our formulary strategies quickly target many of the current market challenges.

  • Standard: Our Standard Formulary identifies and promotes the most clinically appropriate and cost-effective products in a given therapeutic class.  It covers most FDA-approved drugs.
  • Precision & Precision Plus: Our Precision Formularies leverage exclusion strategies to promote lower-cost alternatives in select drug categories while still maintaining robust drug coverage for members.
  • Core: Our Core Formulary provides the most focused drug coverage by leveraging drug exclusion strategies and promoting generics, authorized generics, and biosimilars.

Search for covered drugs

We’ve made it simple to view our drug lists from anywhere, with our easy-to-use formulary drug lookup tool.


What formulary management solutions are available?

We provide our customers with a variety of innovative solutions and have experts who understand the most granular aspects across all these solutions. We understand the value of technology and constantly explore ways in which technology and automation can be leveraged within formulary management to deliver more complex solutions, faster.

What we offer:

prior authorization | magellan rx managementPrior Authorization

We offer end-to-end prior authorization services, which include criteria creations and case reviews.

Adjusdication | Magellan Rx Management Adjudication

Our team of experts manage complex adjudication needs using next-generation technology that serves as our one source of truth. For any custom clients that want more control, we can provide self-service features.

communications | magellan rx managementCommunication

Any formulary changes and enhancements will be communicated to the member and all parties involved in the members’ care in a timely manner.

Publications | Magellan Rx ManagementPublications

Customers can access our industry-leading publications by checking out our formulary drug lookup tool, Pipeline ReportsClinical Alerts, Trend Alerts, and more!

Innovative formulary programs | Magellan Rx Management

Innovative Formulary Programs

To combat current market challenges, we have created multiple formulary programs that can be layered on top of our current formulary offerings to provide additional control depending on our clients’ needs.


Want to learn more?

Connect with us today to learn more about our formulary management strategies and how we can help you manage costs associated with rising drug spend.