PBM Companies

Why We Picked Express Scripts?

Express Scripts, a subsidiary of The Cigna Group, is a leading pharmacy benefit manager (PBM) in the U.S., serving over 100 million Americans. They work to make prescription medications more affordable and accessible by managing drug benefit programs for health plans, employers, and government agencies.

Their services include negotiating drug prices, processing pharmacy claims, and offering home delivery options, all of which aim to simplify the prescription process and reduce employees' costs.

OptumRx

Why We Picked OptumRx?

OptumRx is a pharmacy care services company that goes beyond traditional pharmacy benefit management by connecting billions of data points to make informed decisions, tackling trends, and pinpointing solutions for employers. Known for its user-friendly mobile app and convenient home delivery service, OptumRx makes it easier to manage medications, track prescriptions, and streamline the entire prescription process.

Pros

Convenient Home Delivery – OptumRx offers home delivery for prescriptions, adding convenience for employees.
Flexible Scheduling – Supports flexible prescription schedules, simplifying refill management.
Automatic Renewals – Enables automatic prescription renewals for recurring medications, reducing the need for manual reordering.
Affordable Pricing – Provides affordable pricing options for most medications, making healthcare more accessible.

Cons

Delivery Delays – Occasional delays in prescription delivery or refill processing can impact medication schedules.
User Experience – Certain support features may not be as user-friendly or intuitive as expected.
Customer Support Responsiveness – Some employees report challenges in receiving fast responses to inquiries.
Mobile Optimization – The mobile app features are not fully optimized, affecting usability for some employees.

FAQ

How does OptumRx help manage prescription claims?

OptumRx streamlines the management of RX claims, reducing the time spent manually processing and resolving prescription claims.

What are the benefits of using OptumRx's home delivery service?

OptumRx's home delivery service allows employees to receive their medications conveniently at home, avoiding the need for pharmacy visits.

What should I do if my prescription delivery is delayed?

Contact OptumRx customer service for assistance in resolving delivery delays or tracking your prescription order.

Can I track my prescription orders through OptumRx?

Yes, the OptumRx app and website allow employees to track their prescription deliveries in real time.

What are the average delivery times for OptumRx's home delivery service?

Delivery times vary but typically take a few days. However, some employees have reported occasional delays.

Final Note

In conclusion, OptumRx offers a reliable and convenient PBM solution for managing prescriptions through its user-friendly app and home delivery service.

MedImpact Healthcare Systems, Inc.

Features

Patient Assistance Program (PAP)

Manufacturer assistance fill-in

Pass-Through, Admin Fee Only Contracts

Auditable Contract

Not Provided.

Why We Picked MedImpact Healthcare Systems, Inc.?

As one of the largest independent pharmacy benefit companies, MedImpact delivers innovative solutions to help employers manage high pharmacy costs.

With experience spanning over three decades, the provider offers flexible, transparent solutions that give employees control over their benefits and cost decisions. Its most notable services include customizable formularies, cost analytics, member engagement tools, and various clinical programs.

EmpiRx Health

Why We Picked EmpiRx Health?

EmpiRx Health is a clinically driven PMB company that focuses on value-based care. It uses advanced data and AI tools to deliver personalized medication therapy.

Additionally, the provider's unique Member Care Advocacy program proactively supports employees with complex health needs, ensuring better medication adherence, improved health outcomes, and significant savings for employers and employees.

Rightway

Features

Balance Bill Protections

Patient Assistance Program (PAP)

Manufacturer assistance fill-in

Alternative drug sourcing

Not Provided.

Why We Picked Rightway?

Rightway is a healthcare technology company that simplifies the healthcare experience through its care navigation and pharmacy benefit management (PBM) solutions. Their PBM model offers transparent pricing and personalized pharmacy navigation, guiding employees to high-quality, cost-effective medications.

By integrating clinical care navigation with PBM services, Rightway aims to reduce healthcare costs and improve outcomes for employers and their teams.

Prime Therapeutics

Why We Picked Prime Therapeutics?

Prime Therapeutics is a pharmacy benefit manager (PBM) that collaborates with health plans to deliver innovative pharmacy solutions. Their services include managing prescription drug benefits, negotiating discounts with drug manufacturers, and providing clinical support to ensure employees receive appropriate medications.

Overall, Prime Therapeutics offers flexible, customized partnerships and clinical expertise, aiming to support growth, retention efforts, and employee health.

Prescryptive Health

Features

Balance Bill Protections

Patient Assistance Program (PAP)

Manufacturer assistance fill-in

Pass-Through, Admin Fee Only Contracts

Not Provided.

Why We Picked Prescryptive Health?

Prescryptive Health is an innovative PBM company that improves medication access and personalizes healthcare. Using advanced analytics, the provider streamlines care, increases cost transparency, and helps employees make better decisions. Its platform is easy to use and integrates smoothly to streamline prescription management and health outcomes.

Pros

Personalized Solutions – Prescryptive Health tailors healthcare solutions to the individual needs of employees.
Streamlined Medication Access – The platform makes it easy for employees to access prescribed medications, minimizing delays and ensuring quicker patient care.
Data-Driven Care Decisions – Prescryptive Health uses advanced analytics to deliver more effective and informed patient care.
Cost Transparency – The provider enhances clarity in healthcare costs and decision-making.

Cons

Limited Niche Support – Prescryptive Health is limited in handling complex or niche healthcare needs, which may require additional support.
Feature Limitations – Some features may feel underutilized or not fully optimized, and the provider could benefit from additional ones to cover more medical areas.
Slow Integration & Updates – Integration into existing healthcare workflows can be slow, and new updates or features may not roll out quickly enough to meet user demands.
Data Gaps – Employees point out occasional gaps in data or analytics, which impact the platform’s overall effectiveness.

FAQ

How does Prescryptive Health help with PBM?

Prescryptive Health provides streamlined access to prescribed medications, enabling easier prescription tracking and management.

Is Prescryptive Health transparent?

Yes, Prescryptive Health ensures transparency through clear insights into healthcare costs, enabling informed decision-making.

What are the benefits of using the platform?

Prescryptive Health’s platform facilitates streamlined prescription management, real-time data access, and enhanced care coordination with healthcare providers.

How does the provider address the high costs of medications?

Prescryptive Health delivers solutions that promote transparency and help employees make cost-effective medication decisions.

Does Prescryptive Health integrate with other systems?

Yes, the provider integrates with existing healthcare systems to provide seamless access to data and enhance patient care.

Final Note

In conclusion, thanks to its tailored solutions, focus on transparency, and advanced analytics, Prescryptive Health is a reliable PBM solution for managing prescriptions and improving patient care.

WellDyne

Features

Patient Assistance Program (PAP)

Manufacturer assistance fill-in

Alternative drug sourcing

Pass-Through, Admin Fee Only Contracts

Not Provided.

Why We Picked WellDyne?

WellDyneRx is an independent, full-service PBM that customizes solutions to meet clients' unique needs. This includes managing specialty and chronic care patients, who drive the majority of pharmacy spend.

Its approach combines cost-effective formulary management with a commitment to improving medication adherence and patient outcomes.

National Script, LLC

Features

Patient Assistance Program (PAP)

Manufacturer assistance fill-in

Alternative drug sourcing

Pass-Through, Admin Fee Only Contracts

Not Provided.

Why We Picked National Script, LLC?

National Script, LLC is a full-service PBM provider known for its customizable plans and user-centric approach. Its services include detailed reporting, rebate management, and copay assistance, all aimed at lowering drug costs and improving care for employers and employees.

With a reputation for exceptional client service and a commitment to fiscal responsibility, National Script offers personalized, hands-on PMB with the cost-efficiency of a large provider.

CVS Health

Why We Picked CVS Health?

CVS Health, a leading U.S. healthcare company, operates over 9,000 retail pharmacies and provides a wide range of health services. Its pharmacy benefit management division, CVS Caremark, offers more than basic services by providing personalized adherence counseling, negotiating drug prices, and managing prescription plans to help employees save on medication costs.

By integrating retail, pharmacy, and insurance services, CVS Health has positioned itself as a top choice for effective pharmacy management solutions.

Magellan RX

Why We Picked Magellan RX?

Magellan Rx, now part of Prime Therapeutics, is a pharmacy benefit management company specializing in innovative solutions for complex pharmacy challenges.

By combining Prime's strong PBM credentials with Magellan Rx's expertise in specialty drug management, the provider offers a comprehensive suite of services designed to drive affordability, optimize pharmacy spending, and improve employee healthcare.

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