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Clinical Programs

Prescription programs designed to save you costs

Preferred Drug List

MaxCare strongly believes that the preferred drug list helps to fulfill the goal of providing plan sponsors who wish to manage pharmacy expenses with the “lowest net cost pharmaceuticals”. MaxCare’s new preferred drug list savings opportunities provides plan providers with multiple levels of management that produce increased savings to the pharmacy benefit plan. This, coupled with a benefit design that promotes a thoughtful discussion between individual members and physicians, gives confidence that this preferred drug list will minimize pharmacy cost trend.

Therapeutic Substitution Opportunity (TSO) Program

Our Therapeutic Substitution Opportunity program utilizes value based benefit designs to lower member cost in certain classes of drugs while offering the plan sponsor significant savings by taking advantage of lower cost therapeutically equivalent products within the category.

Pharmacist Outreach Program

Our Pharmacist Outreach program utilizes MaxCare pharmacists to contact members and their physicians to educate both about therapeutic alternatives to selected medications currently being taken by the member. This program is an extension of the TSO program.

Prior Authorization

Requiring prior authorization on more expensive prescriptions is a common cost management technique, particularly for specialty pharmaceuticals. Prior authorizations help influence physician prescribing patterns; if lower cost treatments are a viable option they are more likely to be tried first. Prior authorization assures appropriate therapy and helps the plan sponsor examine and anticipate the cost of more expensive treatments.

Quantity Limits

Most plans set a limit on the quantity of medicine that can be dispensed and controls for when members can order refills. These limitations prevent stockpiling and misuse of prescription medications, serving as both a safety control and cost saving measure.

Step Therapy

Step therapy is one of the most effective cost control techniques available. When a member is diagnosed with a condition for which several treatments are available, the plan requires that the lowest cost treatment is tried first. If the treatment is unsuccessful in managing the condition, the member can "step up" to higher cost options. In this way, physician prescribing patterns and the overall drug mix are funneled to the most cost effective treatment, keeping overall costs as low as possible.