Medical Benefit Drug Management

CareContinuum Logo

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 & Features Why It’s Important
Utilization management with built-in dosing Ensures safe and appropriate use of high-cost specialty drugs
OnePA: Cross-benefit utilization management platform Allows for the management of both pharmacy and medical PAs in one single system
Proactive claims pre-payment review Validates claims against Prior Authorization
Prospective site of care redirection Utilizes the most clinically appropriate and lowest cost site of care
Customizable claims edits Validates claims against clinical norms
Extensive medical rebates Provides additional value through our influence and unparalleled experience
Fully compliant capabilities Enables payers to remain compliant with CMS, NCQA and ERISA regulations

  • URAC

  • Accreditation status Accredited
  • Accredited since 1999
  • Accredited program Health Utilization Management
  • Expiration Date 11/1/2021
  • URAC applies to the following strategic locations
    • Whitestown, IN
    • Louisville, KY

  • NCQA

  • Accreditation status Accredited
  • Accredited since 2017
  • Accredited program Utilization Management
  • Expiration Date 12/27/2021
  • NCQA applies to the following strategic locations
    • Whitestown, IN
    • Louisville, KY