Pharmacy Benefit Management | GENEX Services

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For more information, download our Pharmacy Benefit Management Fact Sheet

Pharmacy Benefit Management

Effective management of drug costs requires real change beyond simply managing price. While there are a variety of factors driving cost increases, you need to fully understand how the drugs are used and manage their use to gain greater control over costs.

GENEX’s Pharmacy Benefit Management service empowers employers and workers’ compensation payors to balance drug price and utilization, identify high-risk cases, ensure only approved, appropriate drugs are dispensed, and proactively reduce narcotic addiction. This service helps control and contain medication costs while improving outcomes through maximum in- and out-of-network pharmacy unit cost and utilization, medication safety alerts, claim level formulary enforcement, and comprehensive pharmacy review capabilities.

Why Choose GENEX’s Pharmacy Management Program?

  • Balance drug price and utilization
  • Identify the need for potential intervention from in- or out-of-network claim
  • Maintain a holistic picture of the claim, including clinical and financial oversight
  • Identify high-risk cases
  • Prevent cases that need early intervention from becoming unnecessarily complex
  • Ensure only approved, appropriate drugs are dispensed
  • Proactively reduce narcotic addiction
  • Ensure medication usage aligns with claim agreement
  • Facilitate reduction in medication amount and expenditure