Pharmacy Benefits Management for Government ConstituentsSmart solutions. Lower costs. Improved care.You face many challenges in balancing constituents’ health with their pharmacy needs. Double-digit growth rates for drug costs. Changing federal requirements and strapped state Medicaid budgets. Increasingly complex claim processes. You need management solutions that help you better serve your constituents while controlling your program costs.

You can find them at Xerox. As a leader in government pharmacy benefits management, we develop and implement automated, streamlined processes for any part of your program. With our solutions, your constituents get the most cost-effective therapies the first time with less oversight needed from your staff – helping you retain more resources for your programs.

Expertise for All Pharmacy Program FunctionsWe support the entire prescription cycle, providing any combination of innovative solutions to suit your specific pharmacy benefit needs. Whether you need a few services or a comprehensive pharmacy benefits management system, we scale to meet your program’s goals.

Pharmacy Claims Processing and Prospective Drug Utilization Review (ProDUR)After the prescription is received by the pharmacy, we streamline your claims adjudication process. Our solutions use comprehensive, industry standard ProDUR edits; we also have the flexibility to integrate customized edits to evaluate every prescription and ensure the safest therapies for your constituents. Our pharmacy claims processing system also integrates your PDL, maximum allowable cost (MAC) and other business rules, maximizing compliance with evidence-based decisions based on your constituents’ current eligibility. We instantly alert prescribers of adverse interactions or other potential issues, ensuring your constituents take the safest and most cost-effective therapies. Our proactive approach results in more-informed decisions that conserve your budget, improve prescribing patterns and integrate information with our other cost-saving solutions.

Our advanced pharmacy claims processing system is flexible and easily configurable, allowing you to update systems without spending a fortune on reprogramming. And our active involvement with NCPDP standards and best practice development ensures that your processes are current and compliant with applicable transaction standards, HIPAA privacy rules and MITA guidelines.

Our Services• Electronic submission, transmission and payment of prescription

information for Medicaid, federal, and commercial clients

• Clinical decision support including client-specific formularies and patient profile reviews

• Point-of-sale (POS) prescription drug claims processing, including automated prior authorizations and prospective drug utilization review (ProDUR)

• Retrospective drug utilization review (RetroDUR) programs including prescriber education, pharmacy intervention and surveillance

• Government and supplemental drug rebate program administration

• Standalone and integrated PBM capabilities

• Robust audit and compliance tools, identifying fraud, waste and abuse and returning much needed dollars back into program budgets

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Pharmacy Benefits Management for Government Constituents

e-PrescribingUninformed prescribing and illegible handwriting can result in dispensing incorrect, ineffective or potentially harmful medications. These errors are costly to your budget – and your constituents. Our e-prescribing solutions prevent them before they reach the pharmacy. The web-based submission process eliminates transcription mistakes. And the HIPAA-compliant clinical decision support and preferred drug list (PDL) tools control costs by directing prescribers to the safest and most cost-effective therapies. Our e-Prescribing solution reduces medical errors and redundant procedures, improving safety and fighting fraud – all without extra administrative burdens on your providers.Automated Prior Authorization (PA) ProgramsWhen therapies need PAs for fulfillment, your providers shouldn’t consume extra resources to confirm them. Our sophisticated PA solutions automate 90% of the process by building on your claims processing capabilities. We review constituent-specific drug, medical, lab and coverage histories to confirm if therapies meet your program’s criteria. Your providers can verify PAs online in real time for both specialty medications and non-pharmacy items (such as lab work, nuclear medicine, home health and durable medical equipment). You ensure appropriate therapies are dispensed without placing extra burdens on your providers – or your budget.Retrospective Drug Utilization Review (RetroDUR) and Prescriber Education Our RetroDUR solutions create efficiencies by educating your prescribers on evidence-based guidelines. Our clinical analytics tools review and analyze population-level medical and pharmacy histories (including mental health and specialty medications) to easily find sources of sub-optimal therapies. By targeting these prescribers, we produce a multiplier effect –an intervention to 500 providers can affect more than 5,000 patients. By educating your prescribers, we help foster better medication choices and prescribing practices without large expenditures.Federal and Supplemental Drug Rebate AdministrationOur experience managing drug rebates and rebate administration systems, in addition to developing PDLs and negotiating supplemental rebates, help your program maximize rebates collection. Our rebate system compiles your paid claim data and combines it with CMS-supplied or contractually determined unit rebate amounts to provide comprehensive, accurate

invoices to drug labelers. Our receivables team then gains timely reimbursements with escalating contact methods and settles any disputes. And our solutions provide in-depth reporting so you can monitor your rebate program’s progress anywhere, anytime.

Xerox Audit and Compliance SolutionOur comprehensive portfolio of services offer the opportunity to maximize the effectiveness of a pharmacy benefit program and to improve the financial performance of benefit dollars. Our programs have been designed to provide a thorough, professional and cost effective process to identify fraud, waste, and abuse in pharmacy benefit programs. Our difference is in our approach. We train pharmaceutical experts to be auditors, not the other way around. Our web-based systems deliver the highest degree of automation and transparency allowing you to feel confident that you are preventing incidences of fraud, waste and abuse. Our solutions are proven – we deliver the right combination of people, technology and expertise that has been trusted by government agencies and commercial entities alike.

The Prescription for EfficiencyNo matter how great your need, we provide a range of integrated solutions and proven clinical programs to lower administrative costs, educate prescribers on best practices, and improve your quality of care. And because our solutions are modular and flexible, you can choose the best combination for your unique challenges. We help you maximize budget resources, make administration more efficient, and increase provider and constituent satisfaction.

Just what the doctor ordered.

Our Qualifications• National presence serving 21 programs in

19 states and the District of Columbia• Strategic expertise in reducing pharmacy

expenditures• Manage nearly $13 billion in drug

expenditures annually• Experienced call center professionals

(including pharmacists and pharmacy technicians) responding to more than 4.2 million calls and faxes annually

• Process more than 235 million pharmacy claims for more than 17 million Medicaid constituents every year

• Active involvement with the National Council

Xerox Prime Contract VehiclesCIO-SP3 – Government-Wide Acquisition Contract

GSA 36 (GS-03F-0015V) – Imaging and Mailroom Services

GSA 70 (GS-35F-0278W) – IT Professional Services

GSA 70 (GS-35F-0325V) – IT Professional Services

GSA MOBIS (GS-02F-0167N) – Course Development & Test Admin

CMS CCO – Call Center Operations

CMS MIC Review of Provider – Medicaid Integrity Data Analysis

We are also a subcontractor on several department and agency specific contract

vehicles covering Civilian, Defense, and Homeland Security. Numerous QMS, security and industry-recognized certifications and compliance to include: FISMA, FISCAM, SSAE16, CMMI Level 3, ISO 20,000, Lean Six Sigma, ITIL v3, and PCI.

for Prescription Drug Programs• Decades of experience with commercial HMOs,

state Medicaid agencies, insurance administrators, self-insured employer groups, state employee benefits programs, worker’s compensation programs, and senior drug programs

• 25,000 on-site health care audits throughout the U.S. and Puerto Rico annually

About XeroxXerox is the world’s leading enterprise for business process and document management. Its technology, expertise and services enable workplaces to simplify the way work gets done so they operate more effectively and focus more on what matters most: their real business. Xerox offers business process outsourcing and IT outsourcing services for commercial and government organizations. The company also provides extensive leading-edge document technology, services, software and genuine Xerox supplies for graphic communication and office printing environments of any size.

You can learn more about us at www.xerox.com/federalsolutions.