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Technology

MC-Rx is powered by ProCare Rx, an industry leader in innovative pharmacy management technology since 1988. MC-Rx operates its own internally developed and maintained claims processing adjudication engine.  Every member prescription is evaluated electronically within the same integrated platform in real-time, whether filled by our own mail order/specialty pharmacy or extensive retail pharmacy network.  In just seconds, prescription claims process through up to 1,500+ edits, providing improved clinical outcomes and increased member satisfaction, while at the same time delivering significant cost savings to our clients.

This powerful claims system is PC-based, which offers tremendous flexibility and scalability of plan design.  Once received at the server, each claim is evaluated in a hierarchical order against multiple client-determined edits to verify eligibility requisites, including:  formulary compliance, duplicate claims, pricing discrepancies, incorrect/missing data, and both concurrent & retrospective Drug Utilization Review (DUR), just to name a few. 

The huge advantage for MC-Rx clients is the ability to customize every aspect of benefit plan design, including copays, deductibles, DUR, eligibility, and pricing edits.  Unlike “cookie-cutter” providers, with MC-Rx as your partner in prescription benefits management, your group has the ongoing adaptability and expertise to grow and change with your evolving business landscape.  Your members receive the prescription choices they want, at a price that you need, with the reliability and accuracy you both deserve.  It’s that simple.

It’s your members, your plan design, and your choice – the options are limitless
  • 24/7 Flexible Claims Processing Systems
  • Powerful Web-Based Formulary Management
    • Value-Based Net Cost Formulary Design
  • Medicare Part D Compliance and Reporting
  • Fast Prior Authorization and Step Edit Functionality
  • Mail Order and specialty pharmacy services
  • Class-leading Analytical Reports and Data Warehouse
  • Innovative Member Portal
  • Effective and efficient Rebate Management

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