Individualized Patient Care.
Guaranteed.

We understand that behind each claim there is a person who needs our attention.

At Benecard Services, our top priority is to ensure safety and healthier living for your members. Our comprehensive clinical package is available at no additional cost to our clients and provides the highest levels of personalized care and service to members.

Our clinical programs maximize opportunities to collaborate with members, their prescribers and dispensing pharmacies. From diagnosis to therapies, our pharmacies and nurses conduct a series of comprehensive reviews to evaluate cost savings, member safety issues, and best health outcomes.

Comprehensive Clinical Package

Drug Quality Management

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Patient Education Mailings

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Clinical Reviews

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Drug Utilization Reviews

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Step Therapy

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Clinical Cost Management

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Drug Pipeline Monitoring

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Dose Optimization Program

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Fraud, Waste and Abuse Identification

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Specialty Drug Management

Our 360-degree approach to specialty drug management treats each patient as an individual.

Each and every patient, managed through our Specialty Pharmacy works directly with a team of health care professionals who serve as an outgoing resource during the course of their therapy. Through communication and education we minimize inappropriate prescribing and maximize patient adherence.

One specialty medication can turn a patient's life and plan sponsor's budget upside down. Benecard has implemented robust specialty copay assistance that is valuable to both our members and the plan sponsors. Our experts assist members throughout the enrollment process to waive or significantly reduce member's specialty copays while ensuring savings for the employers.

Pharmacogenetics

It's time to end the trial and error in finding the right medication.

Pharmacogenetics testing reveals metabolic data that identifies whether a medication can be effective for a member. Our team shares this data with the member's prescriber, so they can implement an individual approach to treatment. We can also apply this information in our claims processing system. This intelligent tool improves the member's care and may impact the plan sponsor's bottom line.

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Medical Data Integration

Our proprietary adjudication system supports medical and pharmacy integration, providing us a 360-degree understanding of a member's health condition.

Our system is designed to bridge any gaps in care and prevent treatment duplication and adverse reactions. Using integrated medical ICD-9 or ICD-10 and CPT codes for claims data, we confirm disease classifications and identity instances where disease-to-medication utilization reviews are required. Disease classifications allows us to work directly with members and their physicians on safe, cost-effective use of medications.

By leveraging our claims integration capabilities, we optimize medication adherence, facilitate communication and consistent messaging amongst healthcare vendors.

PATIENT CASE STUDY

Patient Profile: Alice, 67

Alice takes Toujeo to help control her diabetes. Because the medication is a highly concentrated form of insulin, it requires careful evaluation of dosing to give Alice a better quality of life.

A Crucial Safety Check

Because insulin is so critical to Alice’s health, Benecard Services’ pharmacists reviewed the medication to make sure it was the right fit for Alice. They found the submitted claim was for an unusually high quantity of insulin: 120mL for an 80-day supply, or 450 units per day.

Concerned, they immediately consulted Alice’s prescriber. It turned out that Alice’s maximum dose is 150 units per day. If Alice had taken 450 units in a day, she could have developed life-threatening hypoglycemia. Thanks to our pharmacists’ intervention, Alice received the correct amount of insulin.

Alice’s Better Health Outcome

This scenario illustrates the potential for serious health complications from simple dispensing errors. Our pharmacists understand that behind each claim there is a person who needs our attention. Collaboration with the provider and pharmacy is key to achieving better health outcomes.

But this coordination between our pharmacists, the prescriber, and the pharmacy didn’t just potentially save Alice’s life. It also saved the plan $10,000 (based on average wholesale price, or AWP) that would have been spent on excess insulin, even if Alice had never experienced complications. Our pharmacist’s proactive guidance also ended up saving the member approximately $8,000 (AWP).

Benecard’s clinical approach revolves around holistic care – filling the right drug, for the right patient, at the right time and at the best value. Our clinicians leverage an industry-leading technology and data analysis platform, artificial intelligence and machine learning to ensure members receive evidence-based individualized care. In Alice’s case, we’re happy to report that she was satisfied with the outcome and able to continue her treatment uninterrupted.

Our prescription benefits rest on a robust foundational care coordination program. Interested in learning more? Reach out to us to find out more about our clinical care and cost management solutions.

Benefit Advisors & Employees - Want to know more?

Members: Please call the number on the back of your ID card or e-mail member.services@benecardpbf.com Clients: Contact your Client Relations Manager