PBM Member Login
Delivering pharmacy benefit management services the way you expect, the way you deserve.
Background
Through combining years of industry knowledge and expertise with the proven technological superiority of our back office processor, Express Med Pharmacy Services offers a true "open-book" approach to pharmacy benefit management.
Express Med Pharmacy Services provides a comprehensive suite of services to support pharmacy benefit program in-sourcing needs-providing the flexibility to select services based on immediate business objectives, while accommodating future needs. Simply stated, Express Med Pharmacy Services enables a client to be in control of its pharmacy program.
Express Med Pharmacy Services enables its clients to better brand and manage their own pharmacy programs. Leveraging premier technology and leading pharmacy benefit services, Express Med Pharmacy Services's solutions are offered on an a la carte basis-with full price transparency and full disclosure-to maximize your return on investment. We foster an open book approach to making all data and information easily accessible in an easy to comprehend format. This straightforward, full pass-through model puts financial control where it belongs, with the client, and offers the opportunity to eliminate any misaligned incentives and excessive revenue streams tied to drug spend with current vendor arrangement.
Clients can gain increased control of their pharmacy benefit dollars and maximize cost control and quality of care through a full range of pharmacy benefit management services.
Simple Approach
Express Med Pharmacy Services addresses the escalating issues in fiscal management-soaring healthcare costs and eroding margins-while delivering the highest quality of care for plan participants. We address the increased interest of self-funded employers and third-party administrators to gain a greater level of decision-making authority and control over the pharmacy benefit dollars.
Savings
- Disclose 100 percent of all manufacturer rebates and point-of-sale discounts
- Maximize savings with full price transparency
- Eliminate excessive PBM revenue streams tied to drug spend
- Achieve a greater level of cost and clinical control over drug product selection
Quality
- Ease administrative burden and increase operational efficiency through simplified processes
- Enhance the quality of care for employees and their dependents through targeted clinical programs
- Attract and retain employees through innovative benefit programs that promote healthcare involvement and provide convenient access to Web-based tools
Flexibility
- Maximize cost control and quality of care through a full range of customizable clinical management, retail network, mail order and specialty programs
- Experience simplified administration and informed decision support-with on-demand data access and custom-designed reports
- Gain control of pharmacy benefit dollars-with complete financial transparency (Our "open-book" policy)-and maximize cost control and quality of care through a full range of pharmacy benefit management services.
Services
Enrollment and Eligibility: Our system enables clients to perform their own eligibility updates online, real-time or on behalf of their organization. We also can provide full eligibility updates, or updates on an ad hoc or emergency basis.
Benefit Plan Design and Management: Express Med Pharmacy Services can accommodate any plan design option required and can support a virtually unlimited number of benefit design variations. We also provide benefit design configuration support to our clients in accordance with mutually developed processes. Benefit designs can be modified online, in real time, by Express Med Pharmacy Services or client staff.
Electronic Claims Adjudication: Our claims processing system has been designed for online, real-time adjudication of prescription drug claims at the point-of-sale or mail order fulfillment center.
Pharmacy Network Management: We offer a wide range of retail network options, including supporting existing networks or assisting clients in developing proprietary network that meets specific geographic access requirements, desired price discounts, or other service requirements. For Medicaid populations, services can include a national Medicaid network with Medicaid maximum allowable cost (MAC) pricing. The Express Med Pharmacy Services national retail network provides excellent access at aggressive brand and MAC discounts on a full pass-through basis. We do not retain undisclosed "spread" revenue on dispensing fees and AWP percentages. The Express Med Pharmacy Services national network consists of more than 52,000+ pharmacies in all 50 states and in Puerto Rico, Guam and the Virgin Islands.
Mail Services: Express Med Pharmacy Services owns and operates a fully integrated mail order fulfillment center. The facility is automated with state-of-the-art robotic dispensing equipment and interfaces seamlessly into the PBM software solutions for claims processing and reporting.
Specialty Pharmacy: Express Med Pharmacy Services maintains preferred relationships with specialty program providers and can interface with any existing providers. Our approach and philosophy are consistent with retail and specialty providers. We do not maintain a financial interest from these areas. We can assist clients in contracting for these services on an exclusive or open participation basis.
Formulary: We can fully support a client's existing P&T Committee, existing formularies and preferred drug lists or collaborate to create best-in-class models supported by formulary predictive modeling and rebate impact modeling and recommendations. Pharmacist, physician and member-focused intervention protocols provide cost and quality controls to drive generics, preferred drug products and appropriate use. Clinically appropriate, cost-savings opportunities are identified through proactive management of drug therapeutic classes that contain brand drug products expected to be reclassified as generic or over-the-counter. The goal of Express Med Pharmacy Services's formulary is to provide the highest quality pharmaceutical care at the absolute best value. As an independent provider, we have no hidden agendas relative to promoting products to our clients. We can administer formularies based on specific plan designs, or we can provide clients with the tools to maintain their own custom formularies online.
MAC Management: Express Med Pharmacy Services's MAC list and pricing are designed to provide adequate reimbursement to promote generic dispensing by the pharmacy, while achieving competitive discounts and cost controls on generically available drug products. Express Med Pharmacy Services can also develop and maintain a client-specific MAC list or we can provide pricing and utilization support to maintain a clients' own MAC list.
Rebate Administration: All revenue received by Express Med Pharmacy Services from pharmaceutical manufacturers, related to clients' pharmacy programs ("rebates"), are disclosed to our clients. No games-no hidden agendas. Express Med Pharmacy Services will not promote excessive profit at the expense of its clients. In addition, we offer clients the ability to manage and track their own contractual arrangements through our performance-based contract management system.
Clinical Services and Consulting: We welcome the opportunity to contribute our consultative and technical expertise to augment, develop and support any additional clinical programs. Clients also have the option of using Express Med Pharmacy Services's clinical programs, which incorporate complete prescription drug information to reduce the growth rate of prescription drug costs and increase the quality of care and patient safety. Express Med Pharmacy Services's unique approach to managing the prescription drug benefit goes beyond price and product and focuses on utilization. Express Med Pharmacy Services employs a comprehensive clinical management strategy that addresses potential fraud and abuse, compliance and utilization management, formulary maximization, conversion model programs and first-line generic maximization to drive low net cost and the highest quality of care, with potential ingredient cost savings. Our clinical programs have sound, clinically supported criteria that are structured to meet the regulatory standards of NCQA, as well as those of state and federal agencies.
Drug Utilization Review: Express Med Pharmacy Services's pre-dispensing DUR edit checks are performed on an online, real-time basis between mail and retail pharmacies. All prescriptions are checked for participant eligibility and plan design features and are then compared against previous histories of prescriptions filled by the same pharmacy, by other participating retail network pharmacies and by the mail service pharmacy.
Reporting and Information Analysis Solutions: Two main levels of reporting are available from Express Med Pharmacy Services: our standard reporting package (which includes a large menu of unique reports), and our online analytical decision support tool that is designed meet and exceed our clients' expectations.
Call Center: Express Med Pharmacy Services has one primary call center for both member and pharmacy calls. Our representatives are available to respond to inquiries, such as prescription claim questions, benefit plan details, and pharmacy locations. Members will find comfort in knowing they can receive solid, reliable information from an Express Med Pharmacy Services pharmacist through a convenient toll-free number.
Web Portal Services: Express Med Pharmacy Services offers a suite of Web Services that enables clients to interact with the claims processing system using a standardized protocol in a secure environment. This method of access provides clients with the freedom to build products, tools and reports that utilize Express Med Pharmacy Services data throughout their enterprises. Once the raw data is in house, it is the clients' to use as appropriate, thus providing far greater flexibility and return on investment. Our member Web site invites members to learn more about their prescription benefit programs, medication histories, drug information and related industry news. The member Web site can be customized with a client's logo and name, links to the organization's Internet home site, and up-to-date news bulletins about the organization.
