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Pharmacy Benefit Managers

Deliver high-quality care and compliance for optimal patient outcomes

Health plans rely on the expertise of pharmacy benefit managers to help them deliver high-quality care and compliance at the lowest possible cost. Looking ahead to planned and potential industry changes, successful and aspiring PBMs need to be prepared to support a variety of markets, customer and regulatory requirements based on business objectives, tolerance for bearing risk, and shifting marketplace needs.

MedHOK helps improve your partnership with health plans through a compliant, member-focused platform that delivers all aspects of pharmacy management—holistically managing member care.

  • Out-of-the box compliance with Medicare, Medicaid, Commercial and Marketplace/Exchange requirements
  • Proactive tracking of the emerging Star and value-based care landscape to ensure customer plans are prepared for change
  • Comprehensive, single 360-degree view of every member
  • Flexibility to quickly add new clients and configure functionality specific to their needs
  • Patient-specific clinical programs to improve patient adherence and clinical outcomes
MedHOK offers all the pharmacy management technology functions a PBM needs to succeed:  
  • Rx Prior Auth
  • Rx Appeals
  • Rx Grievances
  • External Review
  • Rx ePA
  • MTM
  • Opioid Monitoring
  • DUR
  • Retro DUR
  • PQAS Drug Adherence Gaps
  • Specialty Rx
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Featured Resources:

Government Health Plans

Effort to Rein In Drug Costs Means Major New Initiatives in Medicare Advantage and Part D

While drug costs have been relatively moderate of late, the Centers for Medicare and Medicaid…

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