What We Do
CapturePBM™ – Powered By RxCLAIM®
CaptureRx provides comprehensive PBM services to self-funded hospital employee groups and patient populations of community health centers and managed care organizations. CaptureRx can integrate and manage various pharmacy networks and drug programs to maximize savings and generate savings to include traditional retail networks, 340B networks, and GPO Networks.
RxCLAIM®, a product of the SXC Company, is the backbone of the CaptureRx PBM adjudication and reporting engine. Today, the RxCLAIM® technology, powers 1 out of 5 prescriptions in the industry across some of the largest PBM providers and payers today. CaptureRx marries the best of class PBM with the best of class 340B and GPO systems through CaptureRx’s powerful and proprietary Cumulus™ Platform.
• 64,000 + Retail Pharmacy Network
• Claims Processing
• Claims Payments
• Clinical Services
• Drug Utilization Reviews (DUR)
• Formulary Development
• Help Desk/Customer Service
• Mail Order
• Prescription Cards
Capture340B™ – Powered By CaptureRx Cumulus™
CaptureRx provides full turn-key development and management of a 340B Drug Discount Program for eligible Covered Entities such as: a Federally Qualified Health Centers, Ryan White, Disproportionate Share Hospitals, Children’s Hospitals, Critical Access Hospitals, and Sole Community Hospitals.
• Compliance and Program Design
• 340B Pharmacy Network Development and Contracting
• OPA Coordination
• Pharmacy Data Connectivity (Switch Coordination)
• Wholesale Coordination & Connectivity
• Apexus™ Coordination
• FDDC™ Cash Card & Sliding Fee Program
• Funds Collections and Settlement
• Pharmacy HelpDesk & Account Management
• Online Real-time Automation Powered by CaptureRx Cumulus™
Our staff, from the Implementation, Contracts, and Network Development Departments, works to bring your program on-line and on-time. Aside from the initial eligibility file creation, No FTEs and effort from your side are required.
We identify and contract with pharmacies per clinic, collect and submit appropriate OPA Self Certification Forms, coordinate with wholesaler for account set-up, contract price loads to include Apexus™, EDI creation and feeds, Pharmacy Claims data authorization and feeds from Switch, EFT bank account set-up for pharmacies and your health center, and the FDDC™ (Federal Drug Discount Card), a cash card program to use for your uninsured or sliding fee scale patients so that they can enjoy 340B discounted pricing.
What’s more, once we have you up, we handle the day-to-day questions and issues from your pharmacies and your staff, such as collections and settlement, replenishment orders, inventory remediation, account reconciliation, system training and support, and report help.
CaptureGPO™ Powered By CaptureRx Cumulus™
Eligible hospitals and other government entities can benefit from GPO (Group Purchasing Organization) and Own-use Pricing for their employees retirees and their families. CaptureRx® expands the network to also include contract pharmacies along with your in-house pharmacies. CaptureRx® filters claims to identify claims’ best price and eligibility among PBM, GPO and 340B to maximize savings.