Discover how health plans and pbms
maximize the value of their

Formulary Benefit Design

with Agadia’s fully customizable web-based solution, RxBenefit+

Agadia’s Formulary Benefit Design Solution

Control the creation, implementation and maintenance of custom and standard formularies

With RxBenefit+, you can easily manage formulary modules such as; preferred alternatives, exclusion lists and financial parameters, POS coverage edits and administration types (open, incentive, closed) with any appropriate formulary file.

Quick Facts

Easily facilitate the production of formulary guides on-line

RxBenefit+ allows you to ensure compliance with CMS guidelines and standards for file submission and website publishing. Additionally, RxBenefit+ provides robust reporting capabilities, tracking all formulary file changes and configuration updates.

Features

With RxBenefit+, Health Plans & PBMs Have Full Control Over the Ability to Create and Manage the Following:

Custom & Standard Formularies

RxBenefit+ enables Health Plans, PBMs and other formulary management companies to create and manage one or many Formulary files by using some of the following attributes:

  • Line of Business
  • Defined Tier Definition
  • Assigned Preferred Alternatives
  • Assigned Utilization Management files
  • Assigned Exclusions
  • Assigned Financial Files

Exclusion Formulary Files

Users can create and manage exclusion formulary files based off of the following various attributes:

  • Drug file therapeutic classifications
  • Specific Drug Selections i.e.: NDCs, Drug Name, GCN, GPI and or RXCUIs

Additionally, users are able to assign Exclusions files to one or many formulary files

 

Utilization Management Files

Users can create and manage Utilization Management files based off of:

  • Prior Authorization
  • Step Therapy
  • Quantity and Dosage Limits
  • Gender and Age Limits
  • Drug Selections i.e.: NDC, Drug Name, GCN’s, GPI’s and or Classes
  • Custom Edits

Additionally, users are able to assign UM files to one or many formulary files

Preferred Alternatives

Users can create and manage Preferred Alternative based off of:

  • Drug Name Search
  • NDC
  • AHFS
  • First Databank & Medispan Categories

Additionally, users are able to assign Preferred Alternatives to one or many formulary files

Administration Configurations

RxBenefit+ allows Health Plans and PBMs to configure the administrative components of their platform to meet their business needs. Capabilities include:

  • Role and privileged-based user configuration
  • Line of business hierarchy configurations
  • Documentation management, allowing users to create and import templates for member and provider notifications
  • Custom integrations with PBMs and other enterprise systems

Financial Information

RxBenefit+ also allows Health Plans and PBMs to configure financial attributes for the formulary. Capabilities include:

  • Assign tier-based financial components
  • Financial assignments based on:
    • Formulary/non-formulary status
    • Brand/generic or specialty status
    • Copay guidelines (copay amount coinsurance mail, retail, specialty)
  • Financial assignments to one or many formulary files

Formulary Maintenance, Workflow & Publishing

With RxBenefit+, Health Plans and PBMs can take advantage of the following capabilities:

  • Publication of changes or updates to formulary files and their associated attribute modules
    • Drug data
  • Change management
    • NDC assignment
    • New drugs to market (Brands/Generics)
    • Drug File changes (Medispan & FDB changes/updates
  • Publication workflow process
  • CMS standard web publishing to formulary sites
Resources

Meet All of Your CMS Requirements

With the use of the CMS Formulary Reference File, Health Plans and PBMs are able to build a new Medicare Formulary, update an existing one or compare changes to ensure compliance. Once a formulary is completed, clients also have the capability to submit content to CMS for approval.

Phone

877-575-2533

Email

contact@agadia.com

Location

9 Campus Drive, Parsippany NJ 07054

Schedule Live Demo