Clinical Solutions

PrismRx provides a wide array of health management resources to address members’ needs.

Utilization Management

PrismRx’s utilization management program is designed to encourage the appropriate and effective use of medications, identify optimal drug use, and promote cost-effective drug benefit plan designs for our clients. The program is founded on evidence based drug information, published guidelines and consensus statements, and standards of medical practice.

Prior Authorization Process

PrismRx’s Prior Authorization Process (PA) ensures proper patient selection, dosage, drug administration, and duration of selected drugs. The PA tools are developed to ensure safe, effective and appropriate use of selected drugs.

Medication Therapy Management

PrismRx’s Medication Therapy Management program helps members:

  • Learn more about getting the greatest benefits from their medication
  • Reduce risks by learning how to avoid harmful medication side effects

Through the analysis of a member’s medication history, PrismRx’s clinical pharmacists identify opportunities to collaborate with physicians to reduce drug costs and out of pocket expenses prescription drugs. PrismRx’s care team develops ways to enhance adherence to medication therapy, improve clinical outcomes and decrease potential drug misuse.

PrismRx’s fully integrated program improves health by reducing overall costs through disease management, case management, and health data integration.