Streamline specialty pharmacy operations

Outdated AWP values and claim submission errors can quietly erode pharmacy revenue. Two solutions address this directly:

AWP Resubmission Services automatically monitor average wholesale price changes, identify claims paid using outdated information and enable pharmacies to select which claims to resubmit — recovering lost dollars, improving cash flow and reallocating resources.

Pre and Post Editing adds an automated layer to the CoverMyMeds pharmacy switch, performing financial, clinical, and administrative edits on every claim in real time. It delivers actionable messages that help maximize reimbursement, reduce submission errors and improve staff productivity — keeping your system current with changing payer and industry requirements.

Compliance exposure and audit triggers can result in fines, claim takebacks, and lost processing privileges. Three solutions provide layered protection:

Excluded Prescriber Monitoring checks prescriber identifiers (NPI or DEA) in real time against federal and state exclusion lists, rejecting claims immediately if the prescriber appears on a list — with no system integration required.

Prescriber Schedule Authority validates prescriber DEA credentials in real time, confirms drug schedule and narcotic status and performs NPI–DEA matching to flag invalid or expired credentials before payer submission.

Audit Intervention Service actively monitors for common audit triggers at the point of dispense — plan limitations, quantities exceeded, inconsistent daily dose, and incorrect day supply.

High out-of-pocket costs and missing benefit details can delay therapy starts and increase prescription abandonment. Three solutions address access barriers:

eVoucherRx™ automatically applies eligible electronic coupons at the point of dispense, reducing patient copays with a fully digital workflow that eliminates paper processes and removes the need for a separate Coordination of Benefits claim.

RxBenefit Clarity displays accurate, real-time benefit details — including copays, deductibles, and any lower-cost alternatives — so care teams can reduce prescription abandonment and avoid unnecessary back-and-forth on coverage and prior authorization requirements.

Commercial / Medicare E1 quickly identifies where to route billing claims, streamlining workflow and supporting adherence by avoiding delays caused by missing or outdated insurance information.

Dispensing errors and missed clinical alerts can put patient safety and compliance at risk. Two solutions help identify potential dispensing issues at the point of dispense:

RxSafety Advisor® examines NDC numbers, dispensing quantities, and days' supplies against safe dosing limits, clinical significance scoring, and likelihood scoring. It flags potential look-alike/sound-alike (LASA) medication errors before a prescription is filled, reinforcing pharmacists' clinical expertise.

NotifyRx™ delivers manufacturer-sponsored clinical and consumer safety notifications through the CoverMyMeds Pharmacy Network. Trigger-based alerts pause the transaction before the claim reaches the payer, supporting clinical decision-making at dispense, with participation benefits available for contracted pharmacy network members.