Pharmacy Benefits Management

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DecisionPoint for
Pharmacy Benefits Management

Addressing the complex needs of Medicaid pharmacy benefits programs

The DecisionPoint® for Pharmacy Benefits Management (PBM) solution helps Medicaid agencies adapt to the new requirements from the shift to Medicaid Managed Care and implementation of the Affordable Care Act (ACA). With current PBM solutions slow to adapt to the fundamental shifts these requirements bring to prescription drug programs, DecisionPoint for PBM delivers a modern, flexible solution that includes multi-program management capabilities; a highly-sophisticated, configurable rules engine; and an advanced Prior Authorization (PA) process.

With DecisionPoint for PBM’s multi-program capability, each program can have its own:

  • Beneficiary eligibility criteria
  • Prescriber populations
  • Member pharmacies
  • Benefit lists
  • Fees, unit prices and reimbursement rates
  • Edits and business rules
  • Prospective Drug Utilization Reveiw (ProDUR) configuration
  • Instant PA configuration

Leveraging more than 10 years of proven experience in Canada, DecisionPoint for PBM can help Medicaid agencies improve the management of their drug benefit programs. To schedule an interactive demonstration, e-mail us.