Pharmarcy Benefits Management Services
Flexible solutions that reduce costs and improve outcomes across the continuum of care.
Outcomes-driven care solutions and increased payer efficiency.
Through Prodigy’s technology platform and clinical solutions, payers benefit from a streamlined and frictionless pharmacy program that is comprehensive, turnkey, and scalable to deliver clinical management and cost controls.
Specialized Pharmacy Benefits Management Services
We help control costs, improve outcomes, and ensure that patients receive the care they need.
Cost Control and
Clinical Outcomes
Expertise in Workers' Compensation Claims
Comprehensive Pharmacy Benefits Management Services
Our PBM Solutions
Process Management
Robust National Pharmacy Network
Electronic Prescribing Program
Out-of-Network Bill Processing
Drug Rebate Management
Seamless Bill Review Integration
Customizable Workflows
Home Delivery Service
Clinical Solutions
Automated Utilization Management Program
Prospective and Retrospective DURs
Compound Drug Management
Specialty Drug Management
Real-time Prior Authorization Program
Point-of-Sale Controls
Servicing all your pharmacy needs across the Continuum of Care
Point of Sale & Retail
Physician Office
Institutional Settings
Schedule an introduction with Prodigy’s Pharmacy Leadership
Our team is comprised of experienced pharmacy executives and leaders who are dedicated to creating a better, more transparent experience for payers. Let’s schedule a time to discuss your goals and create a strategy that results in better cost management and greater patient outcomes.
Our Approach to Pharmacy Benefits Management
Proactive Clinical Controls
Prodigy offers a suite of powerful, evidence-based clinical solutions and management strategies developed and delivered by our team of PharmDs and other clinicians, specifically to improve clinical outcomes, help employees return to work and eliminate waste.
Prodigy’s clinical solutions include, but are not limited to, medication therapy management, drug utilization review, opioid minimization program, compound and specialty drug utilization controls, pharmacogenomic drug oversight, and optimizing drug utilization for older adults to medication-related adverse outcomes.
Better, Faster, Smarter Solutions
Prodigy was formed to offer payers and patients better, faster, smarter pharmacy benefits. With decades of experience in pharmacy, workers’ compensation and group health, Prodigy’s founders created a powerful program with three key components:
Patient-centric customer care that delivers responsive, efficient and empathetic care to patients and their family members
Trusted clinical and pharmaceutical resource that provide exceptional clinical interventions to improve patient health outcomes
Robust pharmacy program that is optimized to provide access to the best care at the lowest net cost
Prodigy is doing pharmacy a different way. We are realigning the care continuum and putting patients first and giving back control to payers.
Transparency
It all begins with an idea. Prodigy’s singular focus in aligning the interests of patients, payers and providers and all other stakeholders in the care delivery continuum. Traditional PBMs have operated in secrecy, while payers have experienced inflated drug prices.
Prodigy is a new brand of PBM, an idea whose time has come. Prodigy’s model is founded on transparency without compromise. Free of the unabashed conflicts, Prodigy has raised the bar to an honest and value-driven model that gives payers total control over their drug spend. This is the Prodigy promise. This is why we are unique.
Utilization Management
Prodigy’s fiduciary utilization management helps payers control costs by connecting each payer to a seamless program that optimizes patient health outcomes through an integrated model of proactive clinical interventions and dependable management solutions.
Prodigy’s fiduciary utilization management ensures that each patient is on the right drug (or clinical intervention) at the right time and as soon as possible. Faster interventions help patients get better sooner, which improves return to work rates and overall patient satisfaction. We believe that fiduciary control is a key missing variable in the cost containment equation and a crucial component of Prodigy’s value story.
Pass Through Pricing PBM
Traditional PBMs set up convoluted pricing structures to play games and mislead payers about the true cost of their pharmacy program. Some PBMs claim they are pass-through and transparent, but there is still conflict in the care delivery continuum and misalignment with patients, payers and providers. This means higher cost to payers and more profit to PBMs.
Prodigy has a different value story. We have simplified the convoluted bait, switch and spread drug pricing paradigm by simply placing the interest of clients at the forefront of everything we do. With Prodigy, payers have full control over their pharmacy benefits. Prodigy transparency means we present clients with simplified and clear drug pricing. This ensures clients pay the lowest net cost.
Best-in-Class Analytics
Prodigy offers actionable strategies and programs to effectively manage pharmacy cost through a blend of clinical expertise, decades of integrated business intelligence and advanced analytical tools that enables payers to make informed decisions and take proactive actions to limit exposure.
Prodigy’s best-in-class analytics create custom clinical solutions, benefits and formulary design, therapeutic optimization and clinical outcomes management. Additionally, Prodigy’s databases are configured to conduct advanced financial modeling and predictive analytics to offer clients enhanced reporting and next-level programs to improve patient outcomes and deliver the lowest net cost.