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Pharmacy Benefit Management

Our services go beyond the traditional. We’re committed to continual evolution in order to meet the current and future needs of our clients. No company is better positioned to manage the pharmacy benefit landscape in Canada.

In addition to optimizing the benefits of the prescription drug plan, our solutions help manage the costs, enabling employers to sustain coverage.

We impact the prescription before it is filled. While traditional pharmacy benefit managers attempt to control costs by reacting to incoming claims after the prescription has been filled, our tools impact the prescription instantaneously, before it is filled. We help plan members make better decisions before leaving the pharmacy, resulting in improved health outcomes and cost effectiveness.

We help plan members make informed decisions. We all want better health and lower costs. But unintentionally poor decisions by patients, caregivers and providers get in the way, compromising health and driving pharmacy-related waste. At Express Scripts Canada, we focus on giving better decisions an advantage.

We help our clients design and manage their benefit plan. Our sophisticated team of pharmacists and clinical experts continuously looks for new ways to help clients manage drug plans and provide improved alternatives to traditional plan designs. Each month, our in-house clinical staff members conduct extensive reviews of scientific and clinical data to evaluate new drugs and their role in therapy, as well as their impact on drug plans and fit with clinical programs.

Our pharmacists and other clinical experts develop lists of drugs approved for reimbursement in order to encourage clinically appropriate and cost-effective prescribing.

We screen every prescription – no matter where it is filled – for possible problems such as drug interactions, duplicate therapies, early refills, and, if selected, drug allergies. A message to the pharmacy flags potential complications or abuse, allowing the pharmacist to consult with the patient and, if necessary, the prescribing doctor.

We provide leading-edge claims processing. Our claims processing system automatically verifies eligibility and coverage, calculates co-payment, co-insurance or annual deductibles and allows for online co-ordination of benefits – all in real-time. Built-in system controls, including positive enrolment, days of supply, mark-up controls and dispensing-fee controls, ensure appropriate plan reimbursement.

We ensure the integrity and accuracy of the data in the claims system. Express Scripts Canada’s Audit Programs verify that claims are paid for authorized prescriptions only, and that pharmacies charge prices within their contractual limits. Our clients receive a comprehensive audit program report once each year.

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Express Scripts Canada