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 Key Components & Features | Why It’s Important Why It’s Important |
|---|---|
Key Components & Features Utilization management with built-in dosing | Why It’s Important Ensures safe and appropriate use of high-cost specialty drugs |
Key Components & Features OnePA: Cross-benefit utilization management platform | Why It’s Important Allows for the management of both pharmacy and medical PAs in one single system |
Key Components & Features Proactive claims pre-payment review | Why It’s Important Validates claims against Prior Authorization |
Key Components & Features Prospective site of care redirection | Why It’s Important Utilizes the most clinically appropriate and lowest cost site of care |
Key Components & Features Customizable claims edits | Why It’s Important Validates claims against clinical norms |
Key Components & Features Extensive medical rebates | Why It’s Important Provides additional value through our influence and unparalleled experience |
Key Components & Features Fully compliant capabilities | Why It’s Important Enables payers to remain compliant with CMS, NCQA and ERISA regulations |
