Prior Authorization

We offer a comprehensive range of utilization management programs for high-cost drugs paid under the medical benefit, leveraging advanced technologies and a high-touch, peer-to-peer consultation to ensure appropriate use. Plus, our solutions are flexible and customizable to meet your plan’s unique goals! 

• We apply appropriate utilization criteria for all medications based on medical evidence  
• We incorporate genetic testing requirements for applicable drugs  
• We manage off-label uses through evidence-based research in conjunction with medical policy criteria  
• We apply step therapy requirements and lab validation for coverage, where appropriate 
• We have solutions that are designed to achieve optimal outcomes for patients with specific conditions like hemophilia, oncology, and more   
• We go beyond typical utilization management to develop solutions that optimize dosing and eliminate waste—ask us how! 

The power of integration

Ask us how we can develop targeted solutions to optimize appropriate use, adherence, and cost management for high-cost specialty drugs on the medical benefit.