Healthcare professionals welcome.

As a health care professional, you are important to us. Like any partner, you need up-to-date information. We invite you to review our formulary, learn about our specialty program, download prior authorization forms and find out how we can work together to control the cost of the prescription benefit.

The most clinically appropriate
medications at the Lowest Total Cost.

Did you know that 95% percent of drug plan expenditures are ingredient costs? This fact is even more important when you consider that the formulary is the primary driver of drug mix, which is the most controllable cost factor of drug plans. This is why we focus on the drug mix to achieve the greatest possible cost savings for your patients.

Download and review our formulary here.

Look up your prescription or its generic alternative on our formulary here.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Tier Zero

This unique benefit design directs member utilization away from more expensive therapeutic options to their OTC alternatives. This benefit design provides incentives to members to choose an OTC as their first treatment option by creating a benefit tier (Tier Zero) that has a nominal or no copayment. In doing this, plan sponsors can capture considerable savings, even though no member copayment may be charged. Initially, Tier Zero will apply to two drug classes—Proton Pump Inhibitors (PPIs) and Non-Sedating Antihistamines (NSAs)—but it can easily be expanded when the FDA announces additional Rx-to-OTC.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Step Therapy

This approach works by encouraging appropriate utilization, promoting recognized prescribing guidelines and supporting access to high quality, affordable prescription drug benefits. Step therapy requires the use of one medication before benefits of another are authorized. The pharmacist receives an electronic message at the point of sale notifying them of the requirement.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Dose Optimization

Also known as dose consolidation, this program typically involves the conversion from a twice daily dosing schedule to a once daily dosing schedule of the same medication, using a higher strength.  In most cases, the cost of the drug is the same for both strengths. The savings can be significant.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Quantity Limits

The goal of this edit is to ensure the safe and appropriate use of medications by placing limits on the amount of medication dispensed based on FDA approved labeling of dosage guidelines and evidence-based prescribing patterns.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Prior Authorization

A process that controls plan costs by obtaining approval before benefits can be used to pay for certain prescriptions or refills.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Prospective, Concurrent and Retrospective
Drug Utilization Review (DUR)

Evaluating cost-saving prescription trends prior to writing the prescription, when the claim adjudicates and after prescriptions are filled.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Claims Replay ®

A proprietary analysis tool independently verified by a leading international actuarial firm that demonstrates how much money you could save with Partners Rx as your prescription benefit manager.

Utilization management tools
that help achieve Lowest Total Cost.

We want to keep prescription benefits affordable. To do that, we employ integrated strategies to achieve what we call Lowest Total Cost.

It starts with generics as first-line therapy when appropriate. Our formulary includes all available generic drugs.Some of our Lowest Total Cost plan management programs are summarized below:

• Maximizing over-the-counter (OTC) opportunities by providing coupon programs that convert prescriptions to OTC alternatives when it is appropriate for the member.
• Encouraging therapeutic interchange by notifying members and physicians when a less expensive drug is just as effective as its higher-cost alternative.
• Notifying pharmacists and members of newly available generics.
• Monitoring for compliance to make sure members are following their drug therapy correctly and notifying them and their physicians when they can optimize their dosing regimen through time-release medications.
• Observing a 6-month moratorium on new molecular entities to monitor safety and efficacy before adding them to our formulary.

In addition, we offer these utilization management programs for achieving Lowest Total Cost:

Tier Zero
Step Therapy
Dose Optimization
Quantity Limits
Prior Authorization
Prospective, Concurrent and Retrospective Drug Utilization Review (DUR)
Claims Replay ®
Reporting

Reporting

Detailed and comprehensive prescription benefit management reporting. Information you need to easily understand and quickly assess your plan performance. Account review reports are available online and on demand.