Support Innovative Healthcare Treatment While Optimizing Member Outcomes and Controlling Costs
Pharmacy Reviews You Can Count On
MRIoA provides clinical pharmacy utilization review services and utilization management analytics that support innovative healthcare treatment while optimizing member outcomes and controlling costs.
By partnering with us, Pharmacy Benefit Managers (PBMs) can implement cost-saving solutions while increasing member satisfaction and ensuring members have access to the right medications at the right time.
MRIoA focuses on the following services for health plans:
INITIAL PRIOR AUTHORIZATION REVIEWS
MRIoA can be your fully outsourced solution, or support seasonal overflow work, including after hours, weekends, and holidays.
Reviewers: Pharmacy Techs, Pharmacists, Physicians
We handle appeal determinations for clinical-based denials.
Reviewers: Specialist Physicians, Non-Specialist Medical Directors and/or Pharmacists
MEDICARE COVERAGE DETERMINATION & APPEAL REVIEWS
(Reconsiderations and Redeterminations)
Get the clinical depth you need to ensure full compliance for Medicare.
Reviewers: Non Specialty-Matched and Specialty-Matched Physicians
MEDICARE COMPLIANT PHARMACY & THERAPEUTICS (P&T) COMMITTEE
MRIoA can assist with full P&T committee support and help ensure Pharmacy Benefit Managers are CMS compliant.
Reviewers: Pharmacists, Medical Directors and Specialty-Matched Physicians
Gain access to our proprietary data warehouse covering 220 million lives and 40 years of medical review outcomes. MRIoA Insights™ provides utilization management analytics and industry benchmarking to drive clinical and business decisions. Deepen your view of prior authorizations and appeals by comparing industry-level denial and overturn rates and much more.
MRIoA’s High-Cost Specialty Drug Review Services Include:
- Medicare Parts B and D
- ACA Exchange
Optimize High-Cost Specialty Drug Spend
MRIoA’s specialty drug reviews allow PBMs to leverage physician specialists to ensure adherence to evidence-based guidelines for high-cost drugs. This allows you to support the right treatment for medical conditions, maintain the same efficacy for the patient while reducing cost where a therapeutic interchange is available.
Harness the power of an independent review to ensure evidence-based care and appropriate utilization of treatments.