Comprehensive Oncology Solution

A patient-focused approach to total oncology management 

Our comprehensive oncology solution combines our cost-of-care strategies with a holistic patient care management program to offer integrated, flexible interventions that address the many complexities of cancer care while driving value through both cost savings and improved quality of care.   

At Magellan Rx, we are dedicated to helping people live healthier, more vibrant lives. With individualized care plans and support from oncology professionals, our solution helps to improve patient outcomes and works to provide cost savings that mitigate rising oncology spend. 

 

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Our Solutions

Precision Medicine & Genetic Testing  

Ensures the appropriate, targeted treatment is ordered for optimal outcomes through genomic testing guidelines, availability of drug therapy options, and interpretation of results.  

Prior Authorization 

Manages complex and high-cost drugs by using advanced technologies and dedicated clinicians that deliver high-touch, peer-to-peer consultation to ensure drugs are prescribed according to evidence-based policies; includes dose, frequency, indication, duration, previous therapy, concomitant therapies, medical history, lab values, genetic and genomic testing results, performance status, disease severity  and progression.

Drug Wastage 

Identifies injectable drug waste that occurs due to limited vial size availability from drug manufacturers.

Weight Based Dosing

Applies personalized dosing to high-cost agents to achieve the most appropriate dosing while maintaining safety and efficacy.  

Enhanced Oncology Value

Standard utilization management approach inclusive of FDA labeled indication and compendia recommendations.

Claim Edits

Backed by Magellan’s Therapeutic Assessment Committee, our claim edits ensure medical benefit drugs are paid correctly through dose and frequency-specific claim to authorization matching (including unclassified HCPSCS) and application of the following edits for drugs not in scope of Prior Authorization (PA), including Eligible Diagnosis (ED), Maximum Dosage/Units (MU), and Duration and Frequency. 

Network Fee Schedule

Variable fee schedule aligns provider interests with payers by encouraging lower cost, but equally effective agents through proprietary Maximum Allowable Cost (MAC) and Least Cost Alternative (LCA) pricing strategies for drugs administered in the physician office, home infusion, and hospital   outpatient facilities. In addition, we manage unclassified codes with an NDC pricing tool. 

Specialty Formulary

Enhances the management of medical drug classes to the same rigor as pharmacy drug classes through formulary development. Classes targeted include those with significant spend on the medical benefit, multiple agents available that are clinically appropriate to “prefer,” and biosimilar agent  available or in the near-term pipeline. 

Oncology Care Management

Encompasses patient education, proactive symptom management, care coordination services, and support services (including psychosocial support, community resources, and financial programs) to ensure a high-quality, high-touch experience for cancer patients while simultaneously reducing unplanned crisis interventions. 

Oral Oncology

Utilization management integrated across pharmacy and medical benefits with clinical and financial advantages . Providing improved oversight into complete drug regiments containing a combination of drugs. Along with improved accuracy in measuring true cost savings associated with management programs.