A Clinical Decision is a Fiduciary Decision©

Clinical Support

Formulary Review Program
Description: Clients may request a clinical formulary review to identify areas of high cost and potential intervention. Areas of high cost are identified, the number of impacted members is reported, and solutions are recommended to reduce cost while maintaining or improving clinical outcomes. High cost areas may be related to specific client demographics, regional prescribing patterns, or plan formulary. If medical claims are provided, a correlation between medical and prescription claims may also be provided. Depending upon client needs, reports may be provided monthly, quarterly, semi-annually, or annually.

Medication Therapy Management (MTM) and Wellness Support Program
Description: For those programs and patients eligible or in need of medication therapy management or face to face wellness programs, The Appro-Rx Clinical Team can provide consultation in development and implementation of high quality MTM/Wellness services in any geographical area. Health insurance companies, employers, PBMs and pharmacies may implement MTM services through a variety of models and settings. Individual client needs are considered as customized delivery models are designed. Outcomes reports are included.

Prior Authorization Program
Description: For high cost and/or specialty drugs requiring a prior authorization, a clinical assessment of the patient, in conjunction with care plan goals from the physician and patient information is used to provide a appropriate recommendation for approval or denial of a claim. If the recommendation is approved, an interventional adherence approach is used with the patient to improve therapeutic outcomes. Outcomes are tracked and patient follow up is included.

Patient Adherence Improvement Program
Description: For patients who are identified as non-adherent, individuals may be contacted to identify barriers to adherence, including health literacy, cultural misunderstanding, or socioeconomic variables. Patient interventions will be made to improve medication adherence.

Specialty Drug Program
Description: This program is designed to improve medication adherence, reduce waste and provide close clinical monitoring to all patients on specialty drugs. By utilizing both an approved specialty pharmacy in partnership with a local pharmacy, patients are provided high quality clinical care and monitoring. Outcomes reports are included.

Adherence Newsletter
Description: A monthly newsletter including new drug and disease updates can be provided to clients written in appropriate language for patients, members, and employer groups. Newsletters are intended to provide information to members to improve and enhance patient adherence through education.

Specialty Pharmacy

Specialty Drugs are one of the Top 3 Cost Concerns for healthcare nationally. The high cost of specialty drugs presents an industry challenge without a defined strategy for cost control.

  • Specialty drugs have no standard industry definition.
  • Specialty drugs (without oncology) comprise approximately 4.5% of drug utilization.
  • Specialty drugs comprise 20% of prescription drug costs.
  • Specialty drug costs are dispersed throughout the medical and pharmacy benefits.
  • Specialty drugs are the largest component of the drug pipeline and have no cost ceiling.

The Appro-Rx Team wants to support your business success by proactively developing a customized, transparent and holistic strategy that manages utilization of these high-cost biotech and injectable medications required to optimize wellness in people with complex conditions such as multiple sclerosis, rheumatoid arthritis, other autoimmune conditions, severe asthma, hemophilia, and more.

The Appro-Rx Team recognizes the unique differences in patient populations and provides several options to start managing specialty drugs, regardless of how your current plan is structured. Education for individuals is key. At Profero team, we want to help the employer stay abreast of specialty drug cost and market changes while supporting your employees through education and partnership with their specialty drug needs.

Working in collaboration with a team of qualified pharmacists, The Appro-Rx Clinical Team has established influential relationships that enhance both medical and pharmacy care delivery.


  • Innovative total cost management - strategies and proven incentives and interventions to optimize savings across all the drivers of health costs utilizing combined medical and pharmacy data.
  • Expert clinical review and recommendations for utilization using evidence-based guidelines.
  • Improved health and productivity outcomes - helping employees change behaviors and improve overall health to maintain lower disability risks and optimize the investment of the health care dollars.
  • Superior customer experience with one-on-one support