RFP Resources

RegenceRx is a leading edge, not-for-profit pharmacy benefit management (PBM) program, offering a comprehensive array of services. As a health-plan based PBM with financial risk, we align our incentives with our clients to reduce pharmaceutical trends and promote appropriate medication use.

We outperform traditional PBM programs by lowering prescription cost trends yet still providing excellent service. Our effectiveness results from science-based clinical management, coupled with effective network and rebate contracting. We know what it takes to develop and manage a cost-effective program that flexibly meets the needs of our customers. We have successfully managed pharmacy benefits for more than 20 years.

RegenceRx has experience in providing PBM services to:

• Health plans and other Blues organizations
• Commercial (local and national) accounts
• Medicaid (managed) and Medicare (risk, cost, and supplemental)
• County, city, and state employees
• Insured
• Self-insured
• Trusts and Associations
• Unions
• High-risk insurance pools

As a full-service PBM, we can provide the following services:

• Preferred Medication List (PML)/formulary support
• Consumer tools and information
• Claims processing (electronic, online, real-time)
• Eligibility management
• Coordinate implementation/transition
• Prospective and retrospective drug use review
• Prior authorization
• Call center
• Pharmacy network
• Mail order
• Specialty pharmacy
• Maximum allowable cost (MAC) list
• Rebate contracting and processing
• Enhanced reporting and profiling
• Pharmacy-based care management programs