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 get their prescription
filled 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 have
offered substantial discounts (15-20%) 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 provider most appropriate in meeting their
unique drug therapy needs. Our customer service staff routinely collects
supporting documentation from physician and pharmacy providers and
notifies the pharmacy of choice when their medication has been approved.
They also work with case managers and third party administration staff to
make sure the client is getting the best price and that there is no
duplication of payment between the medical and pharmacy benefit.
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| Biotech Information |
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