Medical Benefit Drug Management

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Express Scripts offers the most comprehensive solution for managing medically billed specialty drugs through our subsidiary, CareContinuum. Our solution applies utilization management, site of care management, claims pre-payment review and drives medical rebates to effectively reduce wasteful spend, while providing services tailored to patients ensuring safety and healthier outcomes. Our comprehensive offering is supported by a guaranteed savings and ROI. The program’s value is delivered utilizing the core components outlined below.

Key Components & FeaturesWhy It’s Important
Utilization management with built-in dosingEnsures safe and appropriate use of high-cost specialty drugs
OnePA: Cross-benefit utilization management platformAllows for the management of both pharmacy and medical PAs in one single system
Proactive claims pre-payment reviewValidates claims against Prior Authorization
Prospective site of care redirectionUtilizes the most clinically appropriate and lowest cost site of care
Customizable claims editsValidates claims against clinical norms
Extensive medical rebatesProvides additional value through our influence and unparalleled experience
Fully compliant capabilitiesEnables payers to remain compliant with CMS, NCQA and ERISA regulations