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Modular technology solutions, and if needed, seamless access to pre-vetted fully integrated services providers on a single platform.
I want to
  • take control of my PBM
  • be my own PBM
  • stay 100% compliant
  • sell my services on the marketplace
Rx Prior Authorizations
Rx Prior Authorizations
FutureRx provides payors a pharmacy utilization management solution pre-configured with streamlined workflows, auto-generated correspondence, auto-authorizations and ePA. Our “no touch” implemention prior authorization solution helps improve operational efficiency, while improving provider and member satisfaction with timely decisions.
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Grievance and Appeals (RD)
Grievance and Appeals (RD)
FutureRx Appeals and Grievance solution is a pre-configured, automated workflow solution for managing and streamlining your organization’s grievances and appeals processes. The appeals and grievance solution allows you to track cases throughout the life-cycle to ensure compliance, quality and timeliness, as well as improve the quality of service provided to its members. The intelligent automated workflow expedites case reviews, decreases manual processes and simplifies the appeal and grievance lifecycle.
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Complaint Tracking (CTM)
Complaint Tracking (CTM)
FutureRx Complaint Tracking Module (CTM) solution is a pre-configured, automated workflow solution for managing and streamlining your organization’s CTM cases. The CTM solution allows you to import the CTM file from HPMS and create, manage and resolve your cases. The export file makes it easy to update CMS on y our progress and resolution efforts. The CTM solution has automated workflows to simplify the CTM process.
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Part D STARS
Part D STARS
The FutureRx Part D Stars module helps plans identify those members who are not getting their prescribed medications that can negatively impact the members health and the plan's Part D Stars rating. By integrating smart alogorithms developed to look at claims history and prioritize member, prescriber and pharmacy outreach. The use of predictive analytics allows health plans to project their stars ratings and impact of adhearance gaps. Users have the ability to rank contract ID, IP and prescriber-level performance. The use of global outreach and auto-generated communications make member and provider communication efficient.
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Drug Management (DMP)
Drug Management (DMP)
The FutureRx Drug Management Program (DMP) tool was developed to help improve the health and wellness of health plan members. The DMP tool provides an efficient workflow that allows the plan to easily work together with the member, pharmacists and providers to address the dangers and risks associated with the use of prescription pain medications. The solution includes all CMS requirements incorporated into an easy to use solution developed to track the important outreach and evaluation needed to make decisions to ensure the safety of the plan's members.
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Formulary Management
Formulary Management
The FutureRx Formulary Management module was developed to provide an agile system to appropriately manage innovative formulary and benefit designs. The simplified workflow process easily tracks formulary progress and reduces redundancy. The simplified system allows the ability to replicate HPMS formulary change analysis and output prior to formulary file submissions. The integrated data validations accurately address CMS MAPD, PDP and MMP formulary requirments. The formulary tool is completely integrated throughout the application to allow formulary UM edits to easily flow through to RX Prior Authorizations and other solutions. The full integration saves time in searching for formulary drugs and alternatives.
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Customer Service
Customer Service
The Customer Service module is a pre-configured, automated workflow solution for effectively handling calls in today’s challenging health plan or PBM environment. The customer service provides the ability to see the entire member profile from enrollment, prior authorization, correspondence, calls and appeals/grievances all at a glance. In addition, the customer service module provides pre-configured call guidance and scripts to ensure customer service agents respond to calls in a correct and consistent manner with a focus on quick and thorough resolution. When there are complex questions or additional support is needed, there is no need to go out of the FutureRx system – everything is handled in one place with comprehensive transparency across the continuum of the call resolution. The customer service solution also provides the ability to make outgoing calls for follow-up completion and to complete outreach campaigns like welcome calls, satisfaction programs or care management initiatives.
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Medication Therapy Management
Medication Therapy Management
The Medication Therapy Management (MTM) module is a pre-configured, automated workflow solution designed to provide health plans and PBMs everything they need to deliver an effective and compliant MTM program.  From initial identification to Member and prescriber consultations, Comprehensive Medication Reviews, Patient Education Consultation to monitoring, the MTM solution provides the tools necessary to not only maintain a compliant MTM program, but more importantly helps the plans improve member health outcomes and promoting drug savings.  The built-in pre-configured assessments and care plan interventions coupled with our call scheduler and global outreach components help reduce redundant calls and improve staff efficiency.
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PDE Insights
PDE Insights
Monitoring Prescription Drug Event (PDE) data is a complex, but important part of an effective Part D pharmacy program. CMS requires PDE data to be submitted accurate and corrected when inaccuracies are identified. While inaccuracies in PDE data are not intentional, the expectation is that all data is completely correct and matches payment attributes related to member eligibility. The PDE insights Module is a pre-configured tool to help health plans and PBM quickly identify potential inconsistencies with PDE data to help the plan make sure the corresponding payments are accurate. In addition to helping plans identify drug events that may be submitted to CMS incorrectly, the tool also helps plans support their data submissions. The PDE insights module tracks, trends and continuously monitors data and provides real-time information to help plans correct data mismatches or errors. The real-time dashboard allows up to the minute insight and implement measures to help prevent future errors.
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FutureRx Solutions
Technology Platform
Next-generation technology for best-in-class results.
Buy one tech module at a time or the Complete Platform.
The FutureRx Technology Platform is the foundation for all our services and solutions, designed from the ground up by the most talented innovators in healthcare. Its advanced technology integrates all aspect of managing a pharmacy benefit program onto a single platform – providing for improved metrics, reporting and data consistency. The FutureRx technology platform is also 100% compliant in real-time. That means when the rules change, our solutions stay fully compliant with all Medicaid and Medicare regulations, and it automatically communicates the information back to you and your team.
PBMaaS
Reclaim control one service at a time.
Wholly ditching your current PBM may not be your desired path. If you’d like to take a more incremental approach, FutureRx gives you the flexibility to reclaim specific functions from your current PBM one at a time with PBMaaS (PBM as a Service). PBMaaS offers you the opportunity to choose from partners who best fit your unique needs and goals, utilizing our innovative technology platform to solve your current PBM problems one at a time – at your own pace.
FRx Marketplace
The FutureRx Marketplace allows you to buy and sell technology and services critical to the management of pharmacy benefits. The FutureRx Marketplace offers access to fully integrated service and technology providers across health plan and PBM processes and functions – as well as the platform to sell your technology or services to other Marketplace participants. Because all Marketplace participants are integrated on the FutureRx platform, you are assured of seamless data transfers and implementation when buying or selling technology or services. The ability to sell the management of services you have perfected over years of applicable practice, provides Marketplace participants with a new stream of revenue opportunity previously untapped in our industry. Imagine the ability to monetize your expertise and assist other entities in providing the best member care. The FutureRx Marketplace also creates a dynamic and competitive ecosystem offering new options for you to source individual services in the most efficient way
PBM in a Box
Our PBM in a Box™ delivers a fully functional, fully compliant PBM solution on Day One. Our solution includes all the people, processes, and technology necessary to manage and operate your pharmacy benefit administration. PBM in a Box allows you to transfer day-to-day operations from FutureRx immediately or take control as your comfort and human capital levels dictate. That means that you can reclaim control of your pharmacy benefit administration without the need for additional human resources or capital – and, at the same time, reclaim the value of your member equity.
Ready to take back control?
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