With the rising cost of prescription medicines, particularly specialty medicines, it’s more important than ever that health plans and government programs do all they can to ensure payment accuracy.
Outpatient prescription drugs account for 5% of Medicaid benefit spend after rebates, but when managed well, they help lower the total cost of care while improving patient outcomes.
We can help.
Improve modularity & interoperability
Easy move from MCO to FFS
Automated prior authorization
States are struggling to balance the growing cost and healthcare outcomes of their Medicaid programs. We streamline processes to design pharmacy programs that address the rising cost of prescription drugs with innovative payment models. Our solution makes it easy for states to move pharmacy benefits from Medicaid Managed Care Organizations (MCOs) back to Medicaid Fee-for-Service (FFS) to take advantage of federal and supplemental rebate programs. Our user-friendly interface allows faster implementation of program changes and easier access to critical information that drive more insightful program management. You’ll increase efficiency and service quality, enhance Medical Information Technology Architecture (MITA) maturity, and our ongoing enhancements mean you’ll always enjoy the latest innovations.
The Point-of-Sale claims module accurately processes claims and encounters to enable rapid deployment of policy changes. It provides maximum security, integrity, and prior authorization output to providers and trading partners while meeting federal requirements.
Drug rebates reduce spend by about 40% a year, but are you getting all you can, as quickly as you can? Gainwell's Rebate Administration is a cloud-based solution that enables state agencies to take full advantage of Medicaid drug rebates. Our solution allows agencies to easily manage any combination of rebate policies, including various federal pharmacy and managed care programs, and federal and state supplemental programs.
Use a forward-looking approach and deep insights to design effective Preferred Drug Lists to maximize drug rebates, lower overall pharmacy program spend and provide the best clinical value while improving patient outcomes and safety.
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