TPA -- Pharmacy Information -- Main

Cost is an ongoing concern for employers who are self-funding their health plans. And a major contributing factor to health benefits expenses are the utilization patterns and associated costs of pharmacy plans. That is why MedBen's team of pharmaceutical experts dedicate themselves to finding intelligent ways to reduce drug spending while ensuring that patients have access to the prescribed medications they need.

Pharmaceutical Horizons provides financial and plan management consultation to MedBen and its customers. Using HIPAA-compliant claims data, Pharmaceutical Horizons develops a series of valuable drug-usage management reports for the employer. These reports, which include patient specific, drug class, and physician prescribing, when compared to industry norms, provide a tool to modify benefit options, if necessary, and educate and influence both physicians and patients in the choice of cost-effective drug therapy.

In addition, Pharmaceutical Horizons targets causes of less-than-optimum treatment outcomes or excessive cost. Through claims analysis, they can identify members whose utilization patterns drive costs or potentially diminish their quality of life.

MedBen also offers employers a selection of respected pharmacy benefit managers (PBMs) to help employers establish benefit designs tailored to their objectives. Professionals analyze the group’s population, match options to goals, and recommend the optimum mix of features to create the right plan at the right price. The group can choose an open or closed formulary, or one with a tiered copay structure.

Each PBM offers a dedicated support staff to self-funded groups, plus a countrywide pharmacy network. Members with Internet access can also visit their web sites to receive plan-specific benefits information, request prescription refills, or locate a pharmacy.

Patients needing maintenance medication may benefit from the convenience and potential savings found in PBM mail order services. Prescriptions are processed and shipped within 48 business hours of receipt, unless the medication must be special ordered or contact with the physician delays the process. All records of patients’ retail and mail order prescriptions are maintained on the same system for easy access, up-to-date record keeping, and comprehensive claims utilization review and reporting.

Prospective employers can use the links below to learn more about MedBen's selection of PBMs. Current clients can use them to order medications or download formulary (preferred drug) lists. (Some pages open in a new browser window.)

Pharmacy Network

PDM

Web Home

http://www.pdmi.com/

Pharmacy Locator

https://www.rxeob.com/secure/rx_logon_single_signon_pdmi_pharmacy.asp

Formulary Lists

If your group uses a single tier or two tier plan, or a three tier copay plan with less than a $15 member copay difference between tier 2 and tier 3, click here for an OUTCOMES FORMULARY arranged by drug class.

If your group uses a three tier copay plan with a $15 member copay difference between tier 2 and tier 3, click here for a FOCUS FORMULARY arranged by drug class.

Formularies are saved in the .PDF format. To view and print a form requires Adobe Acrobat Reader. You can download a free copy of Reader by clicking here.