Esorse is able to customize plan designs so plan sponsors are utilizing drug formulary management tools that address the usage characteristics of each employer and/or employer location.
- Customization and programming of plan designs
- In-house services include cost-management tools such as:
- Generic substitution
- Tiered plans
- Exception coverage
- Prior authorization
- Step therapy
- In-house pharmacy ‘analytics’ for plan design and drug utilization reviews to identify claim trends and health/disease issues at the plan sponsor level.
- Customized trial prescription programs and drug maintenance programs.
- Access to Canada’s most up-to-date database of eligibility criteria for drugs covered by government programs (e.g. high cost/specialty drugs and cancer products), thereby supporting integration of claims to mitigate unnecessary high cost claims.
- Integration of formulary plans with overall plan designs to provide high cost protection (e.g. yearly plan maximums with add-on catastrophic coverage).
Want to learn more? Contact us today!