Pharmacy Benefits
Complete, whole-person pharmaceutical coverage
AmeriHealth Caritas supports members and partners with integrated, in-house pharmacy solutions:
- PerformRx℠, cutting-edge pharmacy benefits management (PBM) services.
- PerformSpecialty®, a full-service specialty pharmacy.
Both companies are wholly owned subsidiaries of AmeriHealth Caritas, and ensure that members can access the medications they need when they need them.
PerformRx: Clinically focused, cutting-edge PBM
PerformRx is a URAC and NCQA accredited pharmacy benefits manager that offers customizable solutions to meet your unique needs — everything from full PBM solutions to specialized à la carte requests, including:
- Maintaining formularies.
- Structuring drug benefits.
- Processing prescription drug claims.
- Contracting with pharmacies.
- Controlling costs.
Our solutions improve patient outcomes and financial performance through a distinctive approach that frequently interacts with members and providers along the way. Our clinical focus is driven by highly advanced proprietary technology, including:
- PerformPA®, an easy-to-use online pharmacy prior authorization tool that simplifies and streamlines the prior authorization process.
- PerformPRO®, which identifies and proactively addresses medication-related problems for members participating in one of our drug therapy management programs.
- PerformMAX, an all-in-one solution for health care data management.
PerformSpecialty: Personalized medication management
PerformSpecialty® is a URAC accredited specialty pharmacy that provides specialty pharmaceuticals to those most in need, with an emphasis on Medicaid and Medicare populations. The medications available through PerformSpecialty are not typically available through local retail pharmacies. The drugs may be high in cost; have complicated storage, distribution, or application requirements; or be used to treat complex and chronic health conditions.
Our personalized approach provides customized care teams and programs to help patients achieve the best outcomes throughout the entire patient journey.
Learn more about PerformSpecialty
Care coordination for Medicaid beneficiaries using specialty drugs
Members on specialty medication therapy for certain disease states can receive care through PerformRx's URAC accredited Drug Therapy Management program. We help these high-risk members develop an optimized medication regimen that addresses adherence, inappropriate medication use, and risk for adverse events.
Our asthma program identifies patients who have uncontrolled asthma and educates them on understanding their treatment regimens and the importance of adherence. Prescribers are notified of noncompliance or suboptimal control in an effort to collaboratively improve patient outcomes. This program has achieved the following results:
41%
acceptance rate on recommended interventions.25%
decrease in ER visits.$600,000
decrease in total health care costs per 1,000 members.Our transitions of care program helps to facilitate patients’ transition from the hospital to home by removing barriers to care and bridging the communication gap between inpatient and outpatient services. Pharmacists complete medication reconciliation services to reduce readmissions. As a result, we've seen a:
44.4%
decrease in 30-day all cause readmissions29.5%
decrease in total healthcare expendituresOur bleeding disorders management program helps members and their families coordinate services for their health care issues, such as acting as a liaison between the member and care providers, or documenting and keeping providers informed when we identify complications that require intervention beyond the capacity of our bleeding disorders nurse care manager.
Through utilization review, care management, and specialty pharmacy network management, as well as reviewing all requests for blood factor products to minimize overstocking and to monitor use, we bring about real cost savings to our health plan customers.
