Government Solutions and Services Medicaid and Public Health Solutions Medicaid Pharmacy Management Enhance care and reduce program costs Connect with us × Delivering for our clients at scale 100M+ pharmacy claims processed annually 11M+ Medicaid members served 30+ years of experience Ensure quality of care for residents State Medicaid programs face double-digit prescription drug cost increases, shifting federal requirements, constrained budgets and increasingly complex processes that stretch resources to the limit. Our comprehensive Medicaid Pharmacy Management system addresses these pressures head-on — streamlining the entire prescription cycle, controlling costs, identifying care gaps and enhancing coordination. The result? Improved health outcomes for residents while maximizing program efficiency. *Source: KFF Uncover gaps in care Gain insights from professional evaluations to identify trends and improve care. Enhance performance Protect your systems and residents while speeding processes. Streamline prescribing Leverage modern ePrescribing capabilities for expanded access and seamless workflows. Achieve program goals and control costs From single program support to full-scale pharmacy benefit administration systems, we adapt to meet your program’s unique goals. Designed by Medicaid experts for Medicaid experts, we continuously invest in our people, solutions, and technology to empower Medicaid, CHIP and other government healthcare programs. Drug Rebate Administration Streamline rebate management, improve invoicing accuracy, simplify reporting and resolve disputes efficiently with configurable, integrated solutions. Learn more Automated Prior Authorization (PA) Systems Automate prior authorization, review clinical histories, verify therapies, support real-time approvals and reduce call center costs with advanced claims processing capabilities. Learn more Audit and Compliance Solutions Prevent losses, recover funds, combat fraud, ensure compliance and safeguard healthcare program resources with comprehensive auditing and expert-driven strategies. Learn more RetroDur and Prescriber Education Programs Improve prescribing practices, reduce costs, enhance outcomes and drive change with advanced clinical analytics and intervention strategies. Learn more Opioid Safety Management Combat opioid abuse, improve care coordination and ensure safer prescribing with advanced integrated digital tools and clinical expertise. Learn more e-Prescribing and ProDur Programs Modernize prescribing, prevent fraud, enhance decisions, streamline operations and improve care with HIPAA-compliant tools. Learn more Featured insights Pharmacy Benefit Management: Smart solutions, lower costs, improved care See the brochure Beyond adversity: A new approach to making Medicare and Medicaid audits beneficial Read the blog
Drug Rebate Administration Streamline rebate management, improve invoicing accuracy, simplify reporting and resolve disputes efficiently with configurable, integrated solutions. Learn more
Automated Prior Authorization (PA) Systems Automate prior authorization, review clinical histories, verify therapies, support real-time approvals and reduce call center costs with advanced claims processing capabilities. Learn more
Audit and Compliance Solutions Prevent losses, recover funds, combat fraud, ensure compliance and safeguard healthcare program resources with comprehensive auditing and expert-driven strategies. Learn more
RetroDur and Prescriber Education Programs Improve prescribing practices, reduce costs, enhance outcomes and drive change with advanced clinical analytics and intervention strategies. Learn more
Opioid Safety Management Combat opioid abuse, improve care coordination and ensure safer prescribing with advanced integrated digital tools and clinical expertise. Learn more
e-Prescribing and ProDur Programs Modernize prescribing, prevent fraud, enhance decisions, streamline operations and improve care with HIPAA-compliant tools. Learn more