Cost-effective drug therapy for claimants
RJ Health Systems provides Pharmacy Benefit Managers with access to clinical staff to evaluate pharmacy records and improve overall clinical outcomes in both the Group Health and Workers’ Compensation arenas. We perform the due diligence that can control and better manage overall spending, while avoiding costly future medical interventions that may result from side effects, duplicate therapy or the long-term clinical impact of prolonged exposure to medication.
Our analysts can review individual or group claims to identify drug-related issues. We conduct provider outreach, contacting the prescriber’s office to discuss matters related to diversion, early refills, under/over-utilization, and drug-drug or drug-medical condition interactions. We develop and maintain a Maximum Allowable Cost (MAC) database to determine appropriate pricing for generic drugs.
To address billing concerns of Pharmacy Benefit Managers, we have developed specific databases related to HCPCS/CPT® coded drugs, Part B or Part D, and injectable drug management.
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