Get to Know MemberHealth
Background
MemberHealth, founded in 1998, is a national Prescription Benefits Manager (PBM) headquartered in the Cleveland suburb of Solon, Ohio.
- Ranked #1 in customer satisfaction by the Centers for Medicare and Medicaid Services (CMS) in a survey of Medicare enrollees
- Named one of the fastest-growing companies in the United States by Inc. magazine
Read the news release - Ranked #1 in overall member satisfaction by Wilson Health Information Read the news release
- Administers benefits for one of the nation's largest Medicare Part D Prescription Drug Plans
- Administers prescription drug benefits for nearly 5 million people
- Network of more than 63,000 pharmacies, including not only all major chains but also thousands of hometown pharmacies across the country
The MemberHealth Advantage
Cost Control: We team up with community pharmacists to control costs by focusing on clinical efficiency. We save money for beneficiaries and the plan by moving them from expensive brand-name drugs to therapeutically equivalent generics. We are then able to use that money elsewhere to improve health outcomes, such as in our interventions and outreach programs.
- Industry-leading generic dispensing rate of 66%
- Clinical intervention program that has shown our ability to reduce beneficiary co-pays an average of $28.54 and plan costs by $10.16 per intervention
- Diabetes initiative that has increased utilization of life-enhancing ACE inhibitors to more than 65%, 20% higher than the national average Read the news release
- Medication Therapy Management (MTM) programs conducted at the pharmacy level that are designed to identify duplicate therapies and age-inappropriate medications in order to reduce health risks and overall health costs for members while switching them to more effective medicines that are on the plan's formularyRead the news release
Flexibility: We believe there is no single solution to prescription drug benefit management. We work with clients to:
- Analyze and understand their needs
- Develop custom options
- Manage performance related to goals
- Tailor funding options
- Maintain present plan design through CMS waivers
- Offer fully insured and self-funded options
Customer Focus: Here’s how we can service retirees as well as plan sponsors.
- Support the relationships between the patient, the pharmacist and the physician
- Member's Welcome Medication Review is conducted by a local pharmacist to help the member transition into a new plan
- Face-to-face Medication Therapy Management (MTM) sessions with local pharmacists for those members with more intense medical conditions
- Convenient 90-day supplies of medication at retail cost, instead of an impersonal mail-order service
- Formularies developed and reviewed by independent team keeping in mind the best interest of members and their physicians
- National retail pharmacy network, including all major chains in the U.S., District of Columbia, Puerto Rico and the U.S. Virgin Islands
- Toll-free customer service support available 24 hours a day, seven days a week
- Web sites customized to each retiree group
- Dedicated and experienced account management
Contact Information
With our strategic partnerships, flexible plan options, market knowledge and focus on patient-pharmacist relationships, we’ve earned the right to be known as The Part D People.™
For more information, please contact us at: 1-877-285-8759
The product offerings contained herein are underwritten by American Progressive Life & Health Insurance Company of New York, Pennsylvania Life Insurance Company, The Pyramid Life Insurance Company and Marquette National Life Insurance Company. MemberHealth is an affiliate of, and subcontractor to, the foregoing insurance companies.