Clinical Services
Clinical Services for Safe, Cost-Effective Medication Use
Our Programs
Prior Authorization
A responsible review process that requires approval before coverage of select medications or services. This ensures treatments are clinically appropriate, helping prevent unnecessary or unsafe prescriptions.
Step Therapy
Guides members through a cost-effective treatment path, starting with proven first-line options before progressing to advanced therapies when medically necessary. This approach balances quality care with sustainable plan costs.
Quantity Limits
Sets clinically appropriate limits on medication dispensing to prevent overuse, reduce waste, and minimize risk, ensuring members receive the right amount of medication tailored to their needs.
SmartBlock
By excluding wasteful medications from our formulary, SmartBlock protects against high costs while ensuring access to effective, lower-priced alternatives, effectively mitigating overspending risks associated with manufacturer coupons.
SmartBlock saved a current MaxCare client $147,000 in costs on ONE DRUG for ONE PATIENT in 2024.
Why Choose MaxCare Clinical Services?
- Protect member health through evidence-based controls
- Drive meaningful cost savings without sacrificing quality
- Streamline pharmacy workflows with real-time technology
- Maintain compliance with evolving industry standards
- Support clear communication with members and providers
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