What is our Medicaid Fee-For-Service program?
As industry leaders in Medicaid pharmacy programs with more than 40 years of experience, we deliver a best-in-class healthcare experience for our state partners. For this program, we partner with our state customers to manage their pharmacy benefits.
As a leader in the Medicaid space, we:
Know the specialty trends
We have a deep understanding of specialty trends that are driving state Rx programs
Work closely with CMS
Together, we focus on outcomes-based contracting and can bring this expertise to your state
Focus on lowest net cost
We are experienced in the negotiation of supplemental rebates to get the lowest net cost.
Combat the opioid epidemic
We recognize the severity of the opioid epidemic and have specialized programs in place to address it
Help states successfully implement programs
We help states successfully implement and operate programs created under the Medicaid Drug Rebate Program
Our Differentiated programs
Implementing the country’s first PDL program in 2001, we have continued to be the pioneer in the PDL space, offering individual state PDL programs and the first two of the country’s three PDL pools, National Medicaid Pooling Initiative (NMPI) and The Optimal PDL $olution (TOP$).
Flexible Point of Sale (POS) System
Our POS solution brings efficiency and accuracy to provide the best care for members. This includes making sure all claims administration is correct and adjudicated, so members get the right drug at the right time. Our thoughtful, integrated features like auto prior authorization and lab value integration enhance the efficiency and accuracy of collecting claims data.
We have 25 years of experience in administering ADAPs, adapting our government pharmacy solution to meet the needs of state ADAPs and providing an efficient and cost-effective program to support eligible state ADAP clients.
In addition to our PDL, POS, and ADAP programs, we seek to create innovative solutions for our customers through value-based contracting with manufacturers and management of high-cost specialty drugs.
Work with our government experts
We support more than half of the nation’s states to lower overall program costs to taxpayers while preserving a robust drug benefit for recipients. Our cutting-edge pharmacy solutions are tailored and proven in multiple state government healthcare programs.
Interested in learning more?
We’re happy to answer any questions you may have regarding our Medicaid Fee-For-Service program. Send us a note!