Maxcare Solution

MaxCare has created a biotech/specialty medication program that maximizes the best features of several biotech/specialty pharmacy programs.

Patient Choice—Health Plan members can choose to fill their prescriptions from one of the 264 participating biotech retail pharmacies or our mail order partner Medex BioCare.

Note: the medication can be delivered/mailed to the physician’s office if physician monitoring or administration is required.

Cost Savings—Both our retail pharmacy and mail order partner offer substantial discounts: 15-20% less when compared to prices charged when reimbursed as part of the medical benefit.

Medication Cost Management—MaxCare provides prior authorization services for a fixed fee based on the level of intervention. Medications are evaluated for medical necessity, appropriateness relative to other treatment alternatives , existing drug therapies and normative dosing.

Reporting—Biotech medications are tracked for each client via utilization summary reports. Patient-level detail reports are provided upon request and can be forwarded to reinsurance carriers when appropriate.

Coordination of Benefit—MaxCare customer support specialists are trained to work with patients, physicians, case managers, third party administrative staff and pharmacists. Our customer support staff will assist patients in locating the appropriate provider to meet their unique drug therapy needs. Our customer service staff routinely collects supporting documentation from physician and pharmacy providers and notifies the patient's pharmacy of choice when the medication has been approved. They also work with case managers and third party administrative staff to make sure the client is getting the best price and that there is no duplication of payment between the medical and pharmacy benefits.