Plan types
We will work with you to develop flexible and custom benefit designs that meet the regulatory requirements for each plan type. Your plan will be enhanced based on our expert recommendations on factors of your benefit design – including drug levels, formulary coverage, therapeutic classes, and more!
Magellan Rx Management provides comprehensive prescription drug benefits for Medicare-eligible retirees. Magellan has our own contract with the Centers for Medicare & Medicaid Services (CMS), to offer our Granite Alliance Insurance Company Employer Group Waiver Plan (EGWP). We have the expertise and resources to ensure the high levels of service and support required by CMS to administer Employer Group Waiver Plans. We offer customizable plans, allowing our clients the ability to create the plan design and formulary options that can provide their retirees a seamless transition from their original coverage.
Our EGWP plan has demonstrated high success in the industry – recently earning a perfect score rating in our CMS Program Audit! We also earned the PQA Laura Cranston Quality Improvement Award over other PDP and EGWPs nationwide. We continue to strive to improve our plan each year and we encourage you to consider our EGWP for your Medicare-eligible retirees.
Our EGWP plan is a viable option for employer group plan sponsors who already offer EGWP benefits to their members. You can either absorb your membership into our Granite Alliance plan, or we can offer PBM services for your existing employer direct contract. We are also equipped to help transition employer groups who currently offer RDS plans into an EGWP offering. We are able to ensure a seamless transition from RDS into EGWP, while offering savings and reducing your administrative burden. If you’re a current commercial client of Magellan we can coordinate your EGWP benefits to closely mirror your commercial plan to minimize member disruption when they retire into the EGWP plan.
For more information about our EGWP plan, Granite Alliance, please visit our website at https://mygraniterx.com/.
Medicare Advantage plans are one of the fastest growing and most competitive markets in the health insurance industry. MAPD plans are a popular type of plan because they cover multiple services. With a MAPD plan, you’re covered for medical services, hospital stays, prescription drugs, and more. By partnering with Magellan Rx Management as your pharmacy benefit manager we can solution for all the needs of your plan – including Medical Parts B and C Organizational Determinations, as well as the Part D Coverage Determinations.
Magellan Rx Management offers services to both existing plans, and we specialize in helping start-up MAPD plans get off their feet with CMS. We provide a wide variety of delegated services including extensive claims monitoring through the use of our proprietary tools and adjudication solutions. Our thorough claims monitoring results in a reduction of PDE errors which historically has resulted in a 99.8% PDE acceptance rating! We’re happy to provide a full list of all the delegated options available.
We also offer carve-out solutions specific to the needs of your plan – so you can solution for only a few segments of your plan or allow us to service your full plan!
Special Need Plans are an important part of the suite of Medicare plan types, as they offer coverage to the most vulnerable of our population. Magellan Rx Management recognizes the importance of specialized care required for those members who have the disease conditions or low-income requirements that qualify them for these types of plans. We offer sensitivity training for our staff, and work with our clients for any additional cultural training that might benefit the needs of their members. In addition, because many SNP members are institutionalized and in long-term care our Networks team works tirelessly to help support and ensure these locations are part of our network.
Magellan strives to offer flexibility to our SNP members in their benefit options. Our claims adjudication ensures that both Medicare and Medicaid claims consecutively, which ensures that your members will have low to zero-dollar copays at point-of-sale and won’t need to juggle with having the pharmacy process multiple claims to different coverage. We are well positioned to help our SNP clients grow their plans and have historically shown our existing clients tremendous growth potential in their regionalized areas.
Magellan Rx Management is able to support all types of SNP plans – including C-SNP, D-SNP, and I-SNP.
At Magellan we strive to stay current on all regulatory guidance and requirements related to Medicare, as released by the Centers for Medicare & Medicaid Services. In addition to the federal guidelines, we stay informed of all individual state regulatory requirements so that we may best service our MMP clients. We tailor your MMP plans to the combined needs of both the federal and state requirements, ensuring proper compliance on both sides.
For our MMP plans we are fully equipped to support Medicaid encounter data, and able to fully coordinate the benefits between the Medicare and Medicaid side of the plan. We are in a unique position to be able to support both sides of the business. Our claims processing systems cleanly adjudicates the Medicare and Medicaid claims consecutively, which ensures that your members will have low to zero-dollar copays at point-of-sale and won’t need to juggle with having the pharmacy process multiple claims to different coverage.