We’re taking an opportunity to reflect on several of our most viewed articles of 2022. These articles outline key ways that MaxCare is a different kind of pharmacy benefit manager (PBM), including providing the highest level of transparency, accountability, and customer service to every client.

True Impact of Rebates in the Pharmacy Industry

It’s important to understand that while rebates can reduce medication cost, rebates don’t always equal overall cost savings in the pharmacy industry. Expensive medications commonly offer rebates, while an equally effective alternative may be available at a lower cost. Though rebates are an important aspect in determining lowest net cost, it’s important to note that some traditional PBMs keep some or all the rebate’s instead of passing it on to their client.

MaxCare is a 100% pass-through and transparent PBM, meaning that we receive zero revenue from rebates, spread pricing, or other hidden revenue streams. This allows us to simply focus on delivering the most efficient and cost-effective treatments for our clients and their members. When we determine our formularies, we do not consider medications offering the highest rebates, but instead the medications that are the lowest cost and equally as effective.

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Data Analytics

At MaxCare, our belief is data associated with our client’s pharmacy plan is THEIR data. We believe in true transparency so our clients can make the most informed decisions regarding their benefit plan. We want to ensure that you and your plan members always understand what you’re paying for.

Our data analytics team provides the most accurate and up-to-date information regarding the many layers of pharmacy benefit data, such as plan and member cost, clinical solutions, savings, and rebates. Our team is developing a virtual analytics, client self-service tool, MaxAnalytics. This tool allows clients to analyze the specifics of a company’s overall spend and utilization in virtual real-time, allowing for more transparency and control for the plan.

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Specialty Carveout – Cost Containment Strategy

Specialty drugs are high-cost medications prescribed to patients living with complex and rare conditions. These medications are expensive and can cause cost increases to both the plan and members.
Drug manufacturers who produce specialty medications often offer patient assistance programs to help offset out-of-pocket costs. For those medications where the manufacturer provides assistance, they are excluded from the plan’s pharmacy benefit, but offered through this manufacturer alternate funding program. In addition, when the manufacturer does not provide assistance, there are other options such as philanthropic organizations, or charities.

MaxCare clients saved over $2 million in the first six months of 2022 through this cost containment, specialty carveout solution.

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RxEvolutionSM Chronic Condition Management Program

Our chronic condition management program, RxEvolutionSM by MaxCare, supports plan members in managing chronic illnesses like diabetes, asthma, COPD, hypertension, behavioral health, and opioid management. This solution offers community pharmacist support to members and assists them in managing their chronic conditions.

Utilizing this valuable program can improve quality of life and reduce future complications, which in turn can decrease overall medical costs. We proudly work with and support local community pharmacies.

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The MaxCare difference

Whether you’re looking at rebates, data transparency, specialty carveout, or chronic condition management — we are here for you.

We are committed to transparency, accountability, and customer service in everything we do. We want our clients to understand their pharmacy plan. Our goal is cost savings and our priorities are our clients and their plan members care and providing the prescription benefits they need.

Contact us to learn more about the MaxCare difference.