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Pharmacy Utilization Reviews for Medication Optimization

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

APPEALS

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

MRIoA INSIGHTS

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.

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MRIoA’s High-Cost Specialty Drug Review Services Include:

  • Commercial
  • Medicaid
  • 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.

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Resources

ResourcesCase Studies
03/03/2024

How Spark Hire’s Talent Acquisition Suite is Transforming Recruitment for Medical Review Institute of America

Webinars
02/15/2024

Download the MRIoA’s High-Cost Specialty Drug Webinar

High-Cost Specialty DrugsCase Studies
02/09/2024

High-Cost Specialty Drug Review Patient Stories

Read some personal experiences from our High-Cost Specialty Drug Review program.
BlogWebinars
02/08/2024

Download the Election Year Health Check – Washington Insider Webinar

​​​​March 6, 2024 10:00 am PT | 11:00 am MT | 12:00 pm CT | 1:00 pm ET

Why Delay?

Harness the power of an independent review to ensure evidence-based care and appropriate utilization of treatments.

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