Frequently Asked Questions
What does MedImpact do?
Are you owned by a drug company, retail pharmacy or other corporation?
What does managing the pharmacy benefit mean for the member?
What is transparency?
Who are your clients?
Where is MedImpact located?
Do you offer access to your solutions via the Internet?
Do you offer Consumer-Directed Health (CDH) programs?
What drugs are included on the MedImpact Formulary?
What does MedImpact do?
MedImpact is a Pharmacy Benefits Manager (PBM) providing pharmacy service to more than 35 million lives. Our clients include corporations and employers, unions, managed care organizations, health plans, insurance carriers, and third-party administrators, as well as local, state and federal employee programs. We focus on managing the drug benefit to achieve low net cost and superior clinical quality.
As a Medicare Part D participant, MedImpact acts as "the PBM inside" Prescription Drug Plans (PDP) as well as Medicare Advantage with Prescription Drug coverage (MA-PD) plans. We support various plan designs, including the standard drug, actuarial equivalent standard, basic alternative, and enhanced alternative benefit plans.
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Are you owned by a drug company, retail pharmacy or other corporation?
No. MedImpact is a privately-held company. We are the nation's largest PBM that does not sell or distribute drugs. We operate independently from drug manufacturers, drug wholesalers, and pharmacy chain drug stores. This independence gives us freedom to develop our own programs that produce optimal cost and clinical benefits for our clients.
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What does managing the pharmacy benefit mean for the member?
When a member presents a prescription at a pharmacy, the pharmacist connects with the MedImpact system to determine eligibility and perform more than 800 drug safety checks, such as potentially harmful medication interactions and restrictions. This transaction is processed within seconds. Once the prescription claim is approved, the pharmacist usually collects a copay or coinsurance from the member. MedImpact then collects the amount owed from the member's health plan and reimburses the pharmacy for the remainder.
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What is transparency?
To MedImpact, transparency is a trust and partnership philosophy, not a financial arrangement. We believe that clients have the right to know both clinically and financially, what is going on with their drug benefit. This means we are willing to disclose our revenue sources to clients, including the actual average inventory cost (AAIC) for mail-order drugs. We have embraced this high level of transparency since our inception in 1989 because it is the right thing to do. We were one of the first PBMs accredited for transparency in 2005 by the HR Policy Association's Transparency in Pharmaceutical Purchasing Solutions (TIPPS)SM standards.
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Who are your clients?
MedImpact currently provides pharmacy services to more than 35 million lives nationwide. Our clients include self-insured corporations and employer groups, hospitals and health systems, unions, managed care organizations, health plans, insurance carriers, and third-party administrators, as well as local, state and federal employee programs.
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Where is MedImpact located?
MedImpact is headquartered in San Diego, Calif. We have account team members located across the United States to serve our clients. Our Southwest Regional Operations Center, located in Tempe, Ariz., houses a national state-of-the-art call center and full-scale backup of systems and operations in the event of a natural disaster or service disruption.
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Do you offer access to your solutions via the Internet?
Yes. Many of the MedImpact service offerings include Web-based tools. With powerful real-time capabilities, clients quickly and efficiently access the latest MedImpact tools via the Internet.
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Do you offer Consumer-Directed Health (CDH) programs?
Yes. MedImpact supports Consumer-Directed Health (CDH) initiatives. Our consumer-directed tools include spending accounts, cash discount cards, member Web sites, a health management system, and integration with Microsoft® HealthVault™.
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What drugs are included on the MedImpact Formulary?
MedImpact's national formulary consists of drugs that are reviewed by the MedImpact Pharmacy & Therapeutics (P&T) Committee. Formulary drugs are reviewed quarterly for safety, efficacy, indications, ease of use, potential for adverse effects, and cost effectiveness. The P&T Committee consists of physicians, pharmacists, and clinicians representing a broad range of clinical practice and expertise.
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