Health Programs
- Prescription Drug
Program - Medical Management
- Claims Optimization
- Health & Wellness
Prescription Drug Program
Our prescription drug program helps hold down the escalating cost of prescription medications, gives plan members convenient access to the medications they need and carefully screens usage for vital safety factors.
Flexible plan designs
Employers can choose the options that best match their needs.
- Flat dollar co-payment options
- Co-insurance options with minimum/maximum limits
- Three-tier designs
- Optional up-front deductibles
- Choice of mandatory and voluntary generic designs
- Generic substitute and formulary incentives
Pharmacy intervention programs
- Prior authorization – for medications most likely to have certain risk factors
- Quantity limits – for medications often taken inappropriately
- Step therapy – looks for medications as effective as others but less costly
Pricing discounts
- Typical reimbursement is based on a discount from a drug's average wholesale price
- Maximum Allowable Cost (MAC) pricing for generic medications also saves money
Management reports
- Employers have secure access to online reports to monitor prescription drug costs, track usage and examine trends
Fully integrated data
- Prescription drug eligibility information is matched with medical plan information for accurate records and expedited updates
- Data integration helps identify plan members who could benefit from medical management programs
Proprietary pharmacy and therapeutics committee
- Develops and updates our formulary with safety and cost-effectiveness in mind
- Comprised of physicians and pharmacists, both independent and on staff
- Independent from our pharmacy benefits manager
Plan member convenience
- No claim forms
- Retail and/or mail order prescription service
- 24-hour customer service
- Specialty pharmacy provider for chronically ill patients
Mutual of Omaha's prescription drug program is administered by Express Scripts, Inc. Express Scripts contracts with independent pharmacies on behalf of Mutual of Omaha for the national pharmacy network.
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