Providing top-notch customer service is extremely important to MaxCare, and our team is proud to offer true transparency and personalized care while helping reduce prescription costs for our clients. Our clinical services team works hard on behalf of our clients to reduce overall costs through solutions like our MaxChoice, MaxProtect, and SmartBlock programs.

MaxChoice Reference Price Program

Several factors drive the price of prescription drugs, and there are often many drugs of the same type available that can treat conditions with similar effectiveness. Our MaxChoice Reference Price Program allows patients to have a choice in their medication while reducing costs to the plan.

MaxChoice is designed to ensure both the member and the plan has access to the lowest cost, most effective medication. The selected MaxChoice product is assigned a drug-specific cost that saves both the employee and the employer money. If the member chooses to utilize a higher cost medication when an equally effective, lower cost medication is available, they will pay the difference. This program gives the member a choice in the medication they receive without disruption and without affecting the plan cost.

At MaxCare, we want our members to receive the medications they need, but we also want to manage the plan on behalf of our clients. This program allows us to do both by encouraging the use of the lower cost medication that have the same proven safety and efficacy of the higher-cost medications.

A reprice analysis revealed over $300,000 in estimated savings on $2,300,000 in plan spend from MaxChoice alone. Typical savings using the MaxChoice solution equals 5% to 15% of overall plan cost with an average percentage of claims of over 10%.

MaxProtect Specialty Assistance Program

The MaxProtect program is designed to help employees get the specialty and high-cost brand medications they need while reducing the plan’s exposure to these high-cost medications. Spending on new branded drugs is projected to increase to $196 billion dollars by 2026, a 20% increase over the past five years. With new specialty and brand medications being introduced at an astounding rate and with specialty medications typically accounting for 35-60% of overall drug spend for most plans, it’s vitally important for your Pharmacy Benefit Manager to effectively monitor and control costs for these medications. Our team helps verify eligibility and enrolls the patient in relevant manufacturer’s assistant programs in order to help reduce the cost for both the patient and the plan.

MaxProtect saved a 10,000 plus life group $2M a year since 2018. A 2,000 life group saved $480,000 annually, and a 200 life group saved $70,000 annually from this solution. MaxProtect on average results in savings of 15% of overall plan cost and average annual savings to utilizing members of $950.

SmartBlock

Some commonly prescribed medications are actually a combination of one or more drugs that are often more expensive than if prescribed individually. Our SmartBlock Program helps identify the combination drugs that are priced higher than their comparable individual options.

SmartBlock was developed by our clinical pharmacists to identify these combination medications that are currently in the market and those that may soon be coming to the market.

After identifying these combination medications, our pharmacists review clinical evidence to confirm the individual medications are as safe and effective as their combination alternative.

Ready to take advantage of the MaxCare difference?

As a transparent Pharmacy Benefit Manager (PBM), we always have our clients’ needs in mind. We continually do what we can to help you and your employees get the benefits you need at a price that fits your budget.

In addition to our MaxChoice, MaxProtect, and SmartBlock programs, we also have a variety of internal processes that can be implemented to provide additional plan savings.

Contact us today to learn more about how we can help you create the best plan for you and your team.