Better Outcomes at a Lower Cost
- Immediate access to medical data to measure and modify patient trends and behaviors
- Dedicated resources to develop and implement interrelated solutions between physicians and pharmacies
- Greater leverage to negotiate discounts with pharmaceutical manufacturers
- Medical expertise to create tailored programs for long term and chronic diseases
- Consistent strategies to streamline and coordinate administrative and billing procedures
Formulary and Description
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75k)WellPoint NextRx manages more than 400 million prescriptions each year. With a retail network of more than 60,000 pharmacies nationwide, two mail order pharmacies and a specialty unit that dispenses high-cost, bio-tech therapies, WellPoint NextRx doesn’t just make prescriptions and process claims; it provides a comprehensive, proactive approach to pharmacy benefits management.
Responsible Pharmacy Benefits Management
WellPoint NextRx integrates benefits and outcomes to provide clinically viable and financially
sound programs for its enrollees.
GenericSelect – The GenericSelect program promotes the increased usage of generics for on-going conditions: arthritis, depression, diabetes, high blood pressure and high cholesterol. Customers who choose GenericSelect alternatives pay no copays for the first prescription fill of the medication – whether a 90-day mail order supply or a 28-count retail supply. The GenericSelect program also encourages high-prescribing physicians to put newly diagnosed patients on the GenericSelect alternative from the start.
Specialty Pharmacy - Breakthrough bio-tech drugs are revolutionizing care for complex, chronic conditions. NextRx’s specialty pharmacy, PrecisionRx Specialty Solutions, puts people with chronic, complex conditions at the center of a robust specialty medication support program of personal care coordinators, registered nurses and clinical pharmacists. These teams provide intense disease- and therapy-specific care management, help improve communication between doctors and patients, and provide an additional level of support not available through a retail pharmacy.
Mail Order Pharmacy – WellPoint NextRx mail order pharmacies offer a convenient and lower cost alternative to retail locations. Customers can phone, fax or mail pharmacy orders, and use the Internet to order refills. Deliveries can be sent to the customer’s home or office. NextRx operates two of the most advanced mail service pharmacies in the United States. Both facilities use the latest technology to deliver accurate, automated dispensing, and are staffed by a team of licensed pharmacists, board-certified pharmacy technicians and knowledgeable customer care associates.
Behavioral Health/Pharmacy Management – WellPoint’s collaboration between its Behavioral Health Management program and NextRx provide an unparalleled approach to customer safety and care. The result is a decrease in multiple prescribing and an increase in adherence and cost containment. Quality treatment is also supported through the promotion of evidence-based practices.
NextRx Preferred Drug List – The WellPoint NextRx preferred drug list (formulary) is developed using a clinically-focused, outcomesbased process, which means that all decisions consider the health of the customer as the primary objective. The NextRx Pharmaceutical and Therapeutics Committee is comprised of recognized medical and pharmaceutical experts from around the nation. This team assigns clinical designations and determines coverage levels for NextRx pharmacy benefits. <% If (audience <> "Member") Then %> After all clinical pharmaceutical data have been reviewed, an actuarial subcommittee determines the financial components that offer the best total cost of care, from both the health plan and the pharmacy perspectives.
Making it All Work Together
WellPoint NextRx provides employers with a single account management team, a single service
contract and a unified reporting strategy. NextRx customers need only one identification
card, and only one phone line for health and pharmacy questions.
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HealthLink®, Inc., is an Illinois corporation. HealthLink, Inc. is an organizer of independently contracted provider networks, which it makes available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. HealthLink has no control or right of control over the professional, medical judgment of contracted providers, and is not liable for any acts or failures to act, by contracted providers. HealthLink, Inc. is not an insurance company and has no liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. and a separately incorporated and capitalized subsidiary of WellPoint, Inc. Any reference in the material to other organizations or companies, including their Internet sites, is not an endorsement or warranty of the services, information or products provided by those organizations or companies. Discount offerings made available by third-party vendors.