Pharmacy Benefits Configuration

PharmaPlus offers its clients guidance and support at every step. We are aware of your company’s individual needs. Backed by our strong design capabilities, we can create a highly secure pharmacy administration system to support commercial, Medicare Part D, or Medicaid programs.

Our configuration features include:

  • Integrated formularies and drug lists
  • Coverages or clinical programs
  • Copays (patient pay schedules)
  • Accumulators
  • Connected networks and pricings for your benefit plans
  • Direct Member Reimbursement
  • NCPDP D.O compliance
  • Controlled substance dispensing
  • Patient compliance
  • Support for various hierarchical frameworks, such as CAGM, CAGLM, or CGM
  • Ability to create benefit plans by choosing from templates, utilizing similar plans, or creating your own
  • Step-by-step guidance during consultation, installation, and post-setup

We offer unlimited customization with the following features:

Formularies
  • Modify current formularies or create new ones with our prescription benefit manager
  • Draft reports of plan members’ compliance
  • Customize higher copays for non-preferred drugs or lower copays for preferred-formulary medications
Pharmacy Networks around the country, including specialty, mail-order, or retail processes.
Flexible Copay Structures and Designs, such as:
  • Copays based on greater dollar amounts or cost percentages
  • Brand vs. generic copays, by dollar differential
  • Individual and family deductibles
  • Individual and family maximum(s)
  • Tier copay definition at formulary level or NDC level
  • BenefitMAX

Features

Pharmacy Claims Processing

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Pharmacy Benefits Configuration

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Network of Pharmacies

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Administration & Maintenance

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