Clinical Services

There are many choices when it comes to designing your pharmacy benefit, and we work closely with each client to create a customized plan to fit your specific needs. Our clinical management services provide a range of options to help control costs while taking care of your employees.

Our programs align with national treatment guidelines and published clinical evidence, and we ensure that recommended first-line therapies adhere to nationally accepted standards of care.

Standard Recommendations

Prior Authorization and Step Therapy Program

Many traditional medications on the market have a lower-cost alternative, and these programs ensure patients try lower-cost medications first. Learn more about how step therapy.

Quantity Limit Program

This program ensures that dispensed quantities do not exceed manufacturer recommended doses for a given period of time, such as two per day or six per month.

Specialty Medications

Specialty Medication Management Program

This prior authorization program is tailored to specialty drugs, where rising costs can impact a benefit plan significantly. This automatic process helps control the plan spend while ensuring appropriate treatment.

MaxProtect Specialty Assistance Program

MaxProtect assists employees in accessing specialty medications while decreasing the plan’s exposure to their high cost by helping the employee enroll in the manufacturer’s assistance program. When combined with our Specialty Medication Management Program, MaxProtect reduces the chance of missed medications and helps reduce the plan’s cost.

Additional Services

MaxChoice Reference Price Program

MaxChoice 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 in place of a lower-cost medication. This program encourages the use of effective lower-cost alternatives.

MaxOutcomes Personalized Medication Management

This program helps patients who need complex and costly medications better manage their care and helps ensure they successfully complete their medication therapy, as non-adherence is a leading factor in the rising cost of medical claims.

SmartBlock

Some prescription medications are combinations of multiple drugs that are significantly more expensive than the individual component drugs. The SmartBlock program watches out for these high-cost combination drugs and recommends alternative options.

Want to learn more about MaxCare and how our clinical management services help control costs while caring for your employees? Contact us today.

(800) 259-7765

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