When we start working with a new company to design their pharmacy benefit for employees, there are many details to discuss. We talk about what prescription drugs will be covered under the plan, what drugs will fall into the different categories or tiers, and the options that employees have for filling their prescriptions.

Once we’ve designed all the details of the plan, it’s time to enter it into our system so that pharmacy claims can be submitted and approved. When you look at the extensive number of details involved in programming a new prescription benefit plan, it’s clear that human error could occur at any part of the process.

And that’s why we focus heavily on quality and have appropriate checks and balances in place. We have a three-step process for onboarding new clients to ensure we get everything set up right.

  1. One person completes the initial program
  2. a second person performs a quality check
  3. the account manager completes a final round of testing

At each stage, we verify the information in our system against the client’s plan to ensure the employee and client will both end up paying what they expect to pay for each drug.

Our commitment to quality continues with the quarterly reports we provide to our clients, as well as alerts as needed for any activity that needs attention. The quarterly reports are a helpful way for clients to monitor their prescription drug spend and evaluate the overall cost of their plan. After all, one of the primary reasons employers pursue the self-insured model is to take back control of their healthcare spending.

Our clinical services team acts as a watchdog for each plan to ensure employees are getting the right medications and to make recommendations for cost-savings opportunities using generic medications or alternate medications at a lower cost. Our dedicated account managers also monitor client accounts and reach out to them directly to discuss their prescription drug spending and recommend changes that could be made to better fit their needs.

These checks and balances throughout our process help ensure that your prescription benefit plan takes care of your employees while being cost-effective for your company.

Ready to take control of your prescription benefit costs? Contact MaxCare today for more information.