Express Scripts offers the most comprehensive solution for managing medically billed specialty drugs through our subsidiary, CareContinuum. Our solution applies utilization management, site of care management, claims pre-payment review and drives medical rebates to effectively reduce wasteful spend, while providing services tailored to patients ensuring safety and healthier outcomes. Our comprehensive offering is supported by a guaranteed savings and ROI. The program’s value is delivered utilizing the core components outlined below.
| Key Components & Features | Why It’s Important |
|---|---|
| Utilization management with built-in dosing | Ensures safe and appropriate use of high-cost specialty drugs |
| OnePA: Cross-benefit utilization management platform | Allows for the management of both pharmacy and medical PAs in one single system |
| Proactive claims pre-payment review | Validates claims against Prior Authorization |
| Prospective site of care redirection | Utilizes the most clinically appropriate and lowest cost site of care |
| Customizable claims edits | Validates claims against clinical norms |
| Extensive medical rebates | Provides additional value through our influence and unparalleled experience |
| Fully compliant capabilities | Enables payers to remain compliant with CMS, NCQA and ERISA regulations |