Powering Your Success in Regulated Markets

The Capital Building in Washington D.C.

Overview

To grow and serve your Medicare, Medicaid and exchange plan populations, you need a pharmacy benefits partner with proven regulated markets expertise, data-driven insights and innovative solutions. Our experienced and dedicated teams collaborate with you, tailoring our services to meet and exceed your needs for greater affordability, improved quality of care, and compliance excellence.

Offerings

Medicare
Driving higher Star ratings and lower drug spend for Medicare plans

We support more than 6 million Medicare Part D beneficiaries across MAPD, PDP, MMP, DSNP, CSNP, ISNP and EGWP – serving plans that range from less than 1,000 to more than 100K Medicare lives. Our experts can assist with market entry, as well as service-area and plan-type expansions. Plans that leverage our expertise consistently outperform industry benchmarks for HEDIS and Star ratings, while achieving low drug trend.

91% 91%
of MAPD plans using our pharmacy benefits are rated 4-stars or better
42% 42%
of Medicare plans we serve had negative trend – lower drug spending in 2019 vs. 2018
$0 $0
in civil monetary penalties in the last audit cycle
Medicaid
Improving care, cost and quality for Medicaid plans

We partner with health plans to navigate the complex Medicaid market and care for more than 3.5 million beneficiaries in TANF, S-CHIP, CHIP, ABD-LTC and Duals programs across 13 states. With our decades of experience, you benefit from unique insights and best practices that deliver proven results. That includes fostering growth with high-touch support of state discussions and RFPs. Our practices are transparent and we respond quickly to meet new and unique state requirements, offering customized solutions to improve quality outcomes for patients while lowering costs.

85% 85%
of Medicaid plans we serve beat the industry growth trend in 2019
38% 38%
of Medicaid plans we serve had negative trend – lower drug spend in 2019 vs. 2018
99.8% 99.8%
encounter acceptance rate in 2019
Health Insurance Exchanges
Helping you manage the complexities of the exchange marketplace

We serve the prescription drug needs of more than two million individuals across 32 states who are covered by our health plan partners through the ever-evolving exchange marketplace. Both on and off the exchanges, plans rely on us for superior insights – powered by data – and for best practices to meet their goals for greater savings, higher quality care and 100% compliance with government regulations.

100% 100%
compliance rate for 2020, through July
3 3
points higher in diabetes and high blood pressure drug adherence, reducing total cost of care
100% 100%
client retention in 2019
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