Who We Serve

Brokers

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.

Clinical Programs

Here's how Appro-Rx's clinical programs help you and your clients optimize pharmacy care and costs:

24/7 Access to Clinical Pharmacists for emergency prior authorizations, discharge medications and claims processing issues.

Point of Services (POS) Drug Utilization Review is customizable to the client's needs, and ensures that members get the appropriate medication. A variety of drug interactions can be reviewed at POS, including Drug-Drug, Drug-Age, Drug-Gender, Drug-Allergy, and Drug-Disease.

Post Service Drug Utilization Review provides daily review of rejected claims for critical medications. Providers are notified by fax when a critical drug is rejected and no alternative is subsequently filled.

Prior Authorization Review utilizes a step-by-step algorithm to ensure consistency. J-Codes are reviewed for medical benefits, and a daily review of all formulary denials is performed by clinical pharmacists.

Customizable Clinical Programs address client needs in the areas of polypharmacy, high cost members, IV antibiotic discharge programs and disease management programs.

Pharmacy Case Management for high risk members related to COPD, CHF, Asthma, and Diabetes.

Specialty Pharmacy

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.

Our healthcare professionals on our Profero Team guide prescribers to the appropriate medications, based on efficacy and cost. Your members will receive friendly, clinically-accurate support that will help them:

  • Take or administer medications as prescribed
  • Manage any medication side effects
  • Monitor symptoms and responses to therapy
  • Get counseling on health conditions
  • Coordinate new and refill prescriptions
  • Work with insurers to verify benefits