Who We Serve

Employer/Payer

Fomulary and Plan Design

Appro-Rx offers our clients national Commercial, Medicare Part D and Medicaid formularies, along with the flexibility to customize formularies to target individual needs. Our programs feature a range of tiers, with a focus on coinsurance or dollar copayments, including generic and brand at the retail, mail and specialty distribution level. The Appro-Rx programs allow our clients to experience significant savings on Average Wholesale Pricing (AWP) and dispensing fee costs across all tiers.

State-of-the-Art Software

Appro-Rx clients can easily access information about pharmacy reimbursements, rebates, the Maximum Allowable Cost (MAC) list and administrative information on the industry-leading MERLIN portal. Live system access allows our clients to see claims data, MAC list and formulary updates in real time, giving members and providers the data they need for optimal decision-making and efficiency. Here's why MERLIN is the industry's newest and best technology platform:

  • 100% Transparency - clients have real-time access to live claims data
  • Full formulary access and customization
  • Full access to the MAC list
  • Full member profile, including acute medical information
  • Monitoring of Fraud, Waste and Abuse
  • Drug Utilization Review (DUR) implementation

In addition, we offer our clients the ability to share specific portal access with their members and providers. The MERLIN Member Portal, a HIPAA-secure, web-based tool, allows members to easily view details of their coverage, receive Preventive Care alerts and messages, and get summaries of their prescription expenses. Members can easily update their contact information or request replacement ID cards. They can also use the interactive pharmacy search to find in-network pharmacies. The Member Portal's LiveChat feature offers members 24/7 online support.

The MERLIN Provider Portal offers a secure, convenient tool for participating providers. The proprietary technology simplifies Prior Authorization inquiries, offering online authorization request forms and instant verification of member name/ID, authorization ID, and medication status.