A Drug Spend Containment Strategy for Medical Pharmacy

Driving integrated, electronic solutions across the payment life cycle, Emdeon leads the industry with transaction solutions that increase the efficient flow of information among members, providers and employers—and help reduce costs, improve healthcare business processes, and strengthen stakeholder relationships. Through a technology partnership with NovoLogix and the power of its MedRx PrecisionSM application, Emdeon is now delivering enhanced capabilities to immediately impact the estimated $2.1 billion in excess payments currently spent on medical pharmacy claims. Together, Emdeon and NovoLogix are leveraging the latest technology innovations to bring the pricing accuracy and administrative efficiencies that are standard in the pharmacy benefit world to the processing, pricing, payment,and remittance distribution of drug claims paid under the medical benefit.

Consider what MedRX can Deliver
MedRx Precision offers consistent re-pricing and claim edits for injectables, infusables and other pharmaceuticals paid under the medical benefit. Its precise NDC-level data automated drug review applications aids in preventing excessive or inaccurate quantities, streamlining the billing process as a whole. The aggregate NDC-level data across all drugs and services allows for detailed reporting, adds visibility into utilization and dispensing trends data to obtain rebates on all appropriate drugs for claims paid under the medical benefit (consistent with pharmacy benefit rebate strategies). MedRx Precision’s uniform administrative and clinical edits help reduce error rates and can bring even more cost savings to the bottom line. The next generation technology, applications and proven practices, applied to the physician office and home health services, can consistently deliver savings.

Additional Emdeon and NovoLogix MedRX Precision Savings Benefits
With medical benefit pharmacy spend at $36 billion and growing annually, the Emdeon and NovoLogix MedRx Precision collaboration delivers the pricing sophistication and automated efficiencies that health plans, payers, and other partners need to capture drug savings—right from the start.

• A one million member plan spends approximately $118 million* per year in Medical Pharmacy (this spend is not managed by the PBM). Industry experts expect this number to increase 10-20% per year due to the growth of the biotech pipeline. Emdeon has partnered with NovoLogix to provide a direct savings solution for this specific area of spending.


• This solution can save a one million-member plan up to $7 million per year* without changing contractual rates with its provider network.


• Effective January 1, 2008, the Deficit Reduction Act (DRA) mandates that NDCs must be submitted in order to collect rebates for physician office drug claims. MedRx Precision offers a simple and cost effective solution for this mandate.

Interested in more information on this partnership solution? Contact your account manager today or email us at moreinfo@emdeon.com.
*NovoLogix estimates for private health plans based on 2007 IMS data.

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