Pharmacy Review

MRIoA has extensive experience reviewing pharmacy cases. We offer review services to assist with your pharmacy benefit management and can seamlessly integrate into new or existing programs. We currently work with many pharmacy benefits managers and health plans nationwide, assisting at all levels of review.

Pharmacy Review Services

Service Summary

We can assist with all levels of pharmacy review, from prior authorization to specialist, including peer outreach. We offer Pharmacy Technician, Pharmacist, Medical Director, and specialist resources. Services include: drug prior authorizations & appeals, necessity of drug therapy, coverage determinations, tiered drug therapies, step therapy drugs, drug dosage and quantity limits, Medicare Part D coverage determinations, redeterminations and formulary exception requests.

Prior Authorization/Initial criteria reviews (Pharm Techs, Pharmacists, Physicians)

  • Case review based on P/A or other criteria
  • Same day response for all cases received before 3:00 pm MST
  • Cases can be reviewed by MRIoA Pharm Techs, Pharmacists, or Medical Directors; MD’s licensed in all states with same state licensure requirements

CMS Initial PA/Criteria Review: Non Specialty-Matched and Specialty Matched

  • Case review based on P/A or other criteria
  • Cases can be reviewed in client’s system or submitted through MRIoA’s client portal
  • Cases can be reviewed by either a medical specialist or non-specialist, based on client’s need

First & Second Level Review (Pharmacists, Physicians)

  • Cases reviewed based on criteria, medical necessity, or other guidelines
  • Cases can be reviewed at the Pharmacist, Medical Director, or specialist level, depending on client needs
  • Cases can be expedited for an additional fee

CMS Compliant Pharmacy & Therapeutics Committee

  • MRIoA can assist with oversight of RX and Therapeutics committees and help ensure Pharmacy Benefits Managers are CMS compliant.
  • MRIoA can provide Pharmacists, Medical Directors, and/or Compliance officers

General Information Review

  • Non-patient specific, evidence-based review of any drug or topic
  • Addresses issues of medical necessity, experimental/investigational status, appropriate P/A criteria and current standards of care

For a list of drugs recently approved by the FDA you can visit:

Med D Value Pillars

Med D Blinded Case Study

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