Clinical Services

Prescription costs are a significant amount of any employer’s total healthcare spend. Our clinical management programs have been shown to reduce the plan’s total cost by encouraging appropriate and cost-effective use of medications. Our programs align with national treatment guidelines, published clinical evidence, and nationally accepted standards of care.

  • Prior authorization and step therapy programs to ensure employees try lower-cost medications before moving to more costly medications.
  • Quantity limit program to ensure accurate billing, FDA-approved dosage, and cost-effective use of medications.

Our clinical services and account management teams work hand in hand to monitor your plan spend and member utilization at all times. We provide actionable information based on data analytics to help you maximize every cost savings opportunity while also minimizing benefit disruption for your employees.


When a patient is prescribed a specialty medication, it may be the only drug available to effectively treat that patient’s specific need, but it comes at a significant cost for the patient and the employer. Specialty medications are forecasted to account for 50% of drug spending but only 1-2% of total prescriptions by 2020.

Our MaxProtect Specialty Assistance Program helps your employees get the specialty medications they need while decreasing the plan’s exposure to their high cost through enrollment in the manufacturer’s assistance program.


Prescription drugs are priced differently based on many factors in the market, including the uniqueness of a drug, the research investment in creating the drug, and whether or not the drug is still protected by a patent.

The MaxChoice Reference Price Program 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.


Some prescription medications are actually combinations of multiple drugs. Because they are combined, it makes them significantly more expensive than if the component drugs were purchased individually. These combination products and compound kits, as well as some high-cost dermatologic products, can dramatically increase your total pharmacy benefit costs.

Our SmartBlock program watches out for these medications automatically and is continuously updated to include new drugs to the market.