Helping PBMs Manage Appeals to Ensure Proper Coverage at Lower Costs
With the rapid proliferation of new drug 
treatments, Pharmacy Benefit Managers and health insurance payers are under pressure to manage escalating costs, while ensuring their subscribers receive the drug benefits they deserve. Drug utilization review (DUR) is an important component of any payer’s cost containment initiatives, but must ensure the integrity of services to its members.
AllMed provides independent drug review services to leading PBMs that help them to achieve this goal, by providing an objective, evidence-based solution. Our drug review services plug seamlessly into your claims and drug utilization review workflow, allowing you to make member drug benefit determinations with fairness, objectivity, accuracy and timeliness.
AllMed’s staff of in-house physicians perform all drug benefit reviews, by reviewing case records, applying your formulary and the latest clinical evidence to make an objective determination of coverage. Our standards-based review services provide the confidence to your members that they are receiving an objective review of their benefits, and ensures the integrity of your services.
AllMed’s pharmacy review services include:
- Prior authorizations
- Medical necessity of drug therapy
- Drug coverage determinations
- Review of tiered drug therapies
- Review of step therapy drugs
- Review of drug dosage and quantity limits
- Medicare Part D coverage determination and re-determinations
- Coverage Determination Request Forms
- Medicare Exception Requests
- Medicaid drug review
- Private insurance drug review
Are you a PBM or pharmacy benefits payer, looking for an outsourced pharmacy review solution? Email us or call us at 1-888-289-6015 for a free consultation.
