FAQs
Frequently Asked Questions
We understand that navigating pharmacy benefits can be complex. That's why we've prepared answers to the most frequently asked questions. This way, we ensure you have all the information you need at your fingertips.
MaxCare is a Pharmacy Benefit Manager (PBM) that provides pharmacy benefits for companies located across the United States. They emphasize transparency, cost clarity, and outstanding customer service.
As a pass-through PBM, MaxCare shows everything about your plan, including their contracts with pharmacy providers and their rebate contracts, so you understand exactly what you're paying for.
MaxCare has a nationwide network of 67,000 pharmacies, ensuring coverage for employees wherever they go.
The MaxChoice Reference Price Program is a unique program by MaxCare that focuses on select categories of medications where there’s a wide range of low-cost options that are similar in safety and effectiveness across all products. This program allows patients to have a choice in the medication they take while shifting costs away from the plan if a higher-cost medication is chosen.
The MaxProtect Specialty Assistance Program helps employees get the specialty medications they need while decreasing the plan’s exposure to their high cost. It connects patients to the manufacturer’s assistance program by verifying their eligibility and enrolling them in the relevant programs.
The SmartBlock program watches out for certain medications that are significantly more expensive because they are combinations of multiple drugs. This program is updated continuously to include new drugs to the market.
MaxCare serves self-funded employers, brokers, TPAs, and PBM consultants. They help employers design and administer their pharmacy benefits, and partner with brokers and TPAs who share their values of transparency, accountability, and customer service.
MaxCare supports its clients with a dedicated account manager to help with any plan-specific questions. Their customer service team is available to answer any questions from employees about their prescription coverage, and their clinical services team helps analyze spending, ensure employees are getting the right medications, and make recommendations for adjustments to the plan.
A pharmacy benefit manager (PBM) is a company that is responsible for administrating prescription drug programs on behalf of plans and their employees. PBMs assist in decreasing and controlling pharmacy spend, improving adherence, and managing high-cost specialty and brand medications. They help to manage prescription benefits programs by creating formularies, negotiating rebates, creating pharmacy networks, reviewing drug utilization, and implementing clinical programs.
Not all PBMs are created equal. Traditional PBMs generate revenue from a variety of sources, which includes keeping a portion of drug rebates, mail order fees, spread pricing, and other ancillary fees. Because of the complex nature of a traditional contract, traditional PBMs are significantly less transparent with how their revenue is generated, making it harder for the plan to understand exactly what they’re paying for their pharmacy benefits. In contrast, pass-through PBMs like MaxCare pass through all rebates, discounts, and savings to the plan and only receive revenue through a flat administrative fee. This ensures that the PBM has zero incentive to drive utilization based on undisclosed revenue generation and allows them to simply focus on providing the most efficient and cost effective treatment for members with the highest possible member adherence to high-cost medications.
