.png){kind=logo}
Enhanced Support Through
Ancillary Services
OUR PROCESS
With our Ancillary Services, HealthLinX (HLX) takes a comprehensive approach to fine-tuning your benefit plan for maximum efficiency and cost savings. We provide a holistic process that ensures your plan operates with integrity while delivering value to your organization and its members.
Our services include:
-
Formulary Performance Analysis: We analyze your formulary to ensure it aligns with the lowest net cost drugs in each therapeutic class. This helps you avoid financial pitfalls that can arise when PBMs prioritize higher-rebate, more expensive drugs.
-
MAC List Comparison: We conduct detailed Maximum Allowable Cost (MAC) comparisons, evaluating your PBM’s MAC list against federal benchmarks to identify potential overcharges and ensure fair pricing for generic drugs.
-
Fraud and Abuse Management: Our proprietary systems detect and address unusual activity among members, physicians, and pharmacies, protecting your plan from fraud and abuse.
-
Denial of Service Reviews: Our experienced team evaluates denied drug claims to provide informed recommendations that balance cost, benefit design, and member needs.
Pharmacy Benefit
Management Solutions
FORMULARY PERFORMANCE
HealthLinX (HLX) reviews your formulary decisions to ensure you receive the lowest net cost drug in each therapeutic class. Prescription benefit managers (PBMs) may have financial incentives to increase rebates by using more expensive drugs, which is often not the best financial situation for your plan. HLX helps you navigate the pitfalls of the formulary and rebate system to achieve the best outcome.
MAC COMPARISONS
Your prescription benefit manager (PBM) sets a Maximum Allowable Cost (MAC) to create a single reimbursement rate for generic drugs from multiple manufacturers. This prevents arbitrary Average Wholesale Prices (AWPs) set by manufacturers from impacting drug costs. HealthLinX (HLX) will analyze how your PBM’s MAC compares to the Federal HCFA/CMS MAC to identify any potential up-charges to your plan.
FRAUD AND ABUSE MANAGEMENT
HealthLinX (HLX) addresses prescription drug abuse and fraud with proprietary systems designed to protect your plan. We identify and track unusual activity from members, physicians, and pharmacies by comparing their behavior against the established norms of your specific group.
DENIAL OF SERVICE REVIEW
When a member's drug claim is denied, HealthLinX (HLX) can provide a professional, informed review of the circumstances to determine coverage for the member. Our extensive industry experience allows us to weigh all components—not just price or benefit design—before making a written recommendation to the plan.