Health Plans

Envolve Pharmacy Solutions has more than a decade of experience in providing state-funded managed Medicaid programs with Pharmacy Benefit Management (PBM) services across 20 states. We are a partner in managing risk and delivering member-focused pharmacy services that supports better care and outcomes while controlling cost.

Our flexibility and expertise mean we are able to deliver customized total drug management services that are specific to the needs of a managed Medicaid program. We have the advantage of managing cost and trend, thanks to leading-edge data analytics and access to rebate programs that help reduce the cost of drugs for our Medicaid partners.

We deliver high-touch pharmacy benefit services that are built around each individual member, providing them with a personal experience that empowers them to take responsibility for their own health and wellness.  Our innovative clinical programs support the best care and outcomes and help members understand their health conditions, their medications and how to best care for themselves given the resources that their benefits plan provides.

Envolve Pharmacy Solutions for Health Plans include the following:

  • Integrated, total drug management
  • Innovative clinical programs
  • Secure online member portal
  • Education and outreach for members/patients
  • Comprehensive reporting
  • State-of-the-art technology and analytics designed to improve individuals’ outcomes while reducing costs
  • Customized formulary management
  • Benefit design
  • Claims processing
  • 24/7/365 live member service staffed with licensed pharmacy technicians
  • Robust Pharmacy Open Network with more than 65,000 pharmacies
  • Limited and preferred pharmacy network options
  • Online prior authorization process
  • Integration with TPA and other vendor systems
  • Home delivery services through our sister company Homescripts
  • Specialty drug management through our sister company AcariaHealth
  • Fraud, waste and abuse programs
  • Online client access to reports
  • Quarterly and annual plan review
  • Prospective, concurrent and retrospective drug utilization review (DUR) programs
  • Support for open enrollment meetings and benefit fairs
  • Targeted communication, education, and outreach campaign support
  • For members with complex health conditions, we offer completely integrated specialty pharmacy services through AcariaHealth.

For more information about our Solutions for Health Plans, or to request a quote, please call (800) 413-7721.