Managed Health Care Services - The Pharmacy Benefits Specialists

By: Managed Health Care Services  09-12-2011
Keywords: Drug Benefits, Pharmacy Benefit

We specialize in ASO (Administration Service Only) extended health and insured plans through our partners


  • Pay direct drug card
  • Positive enrollment
  • Coordination of Benefits with other public and private insurance plans
  • Flexible benefit options
  • Real time verification of member and benefit eligibility
  • Drug utilization review
  • Toll-free Bilingual services
  • Flexible administration and billing options
  • Comprehensive utilization audits and reports
  • Stop-loss re-insurance coverage
  • Out of country travel coverage
  • Mail order solutions

How We Save On Benefit Costs

There are several areas, that when added together can make a substantial difference to your annual drug benefits costs.

Plan Management:
There are four cornerstones to the management of our Drug Benefits Services:

  • Cost
  • Utilization
  • Care
  • Outcomes

Our Business Model:
MHCSI is a Preferred Provider Pharmacy Benefits Manager. A major objective of the MHCSI business model is to reward loyalty to Preferred Provider solutions with unparalleled value.

Our Administration Fees:
In keeping with this model we have been able to achieve the lowest administration fees in the industry. All of these savings are passed directly to the plan sponsor. Our program enables the plan sponsor to build health credits that may be directly applied to reducing administration fees to the point where they are eliminated.

  Group Benefits Program

  Great News for MHCSI Plan Sponsors
MHCSI is pleased to offer their group Group Benefits Program. All pharmacy benefit group clients will be able to earn annual administration rate credits based upon their participation in MHCSI programs and services.

  How to achieve a “down to zero” administration rate
Plans that participate in Group Benefits Program will be able to earn credits against the MHCSI portion of their annual administration fee, with the level of participation determining the administration rate credit applied at the end of the year. Plans can actually achieve a “down to zero” administration rate. Credits earned during the course of the year will be issued at year end.

Our Program Advantages:
All pieces of our drug benefits management model work smoothly together to deliver cost-effective solutions. This means that you can save money while maintaining or improving upon the quality of your benefit program and member health outcomes.

For specific details on how we would apply this expertise to your business then book a confidential 1-on-1 consultation with us.

Managing Cost
Recent reports indicate that prescription utilization increased by more than 7% over the previous year. According to IMS Health, prescription spending in Canada exceeded $21 billion in 2008. There are some factors that drive costs which are out of your control, such as aging population and new drug development. However, deciding who provides the service, how the plan is delivered and how the benefit is priced is within your control. Consider the following:

  • Savings on administration costs through Preferred Network solutions
  • Generic substitution at the point of care
  • 90 day supplies of maintenance meds.
  • The cost advantage of an integrated distribution network
  • Customized plan designs and formularies that meet your needs
  • Administration Services Only (ASO) benefit design where appropriate
  • Mail order solutions

Managing Utilization
Optimal utilization means that people get the right medication at the right time and at the most cost-effective price. We do this by using the full capacity of our on-line adjudication system coupled with the expertise of our “frontline” pharmacy professionals. Strategies used by MHCSI to achieve this include:

  • Therapeutic substitution protocols
  • Trial prescriptions on new-to-you medications
  • Comprehensive audits and drug utilization review
  • Adherence monitoring and support services
  • Individualized medication assessments
  • Preferred agent listing and tiers

Managing Care
Proper use of medication is integral to the management of many medical conditions, such as high blood pressure, diabetes, asthma, and so on. To ensure that you get good return on your investment in medications, we provide access to the following services at our provider pharmacies:

  • Disease state management programs
  • Customized care plans
  • Individualized medication reviews
  • Appropriate use of prior authorization protocols
  • Formulary design management
  • Adherence monitoring and support

Managing Outcomes
At MHCSI, we believe that workplace wellness initiatives should focus on promoting communication, education and empowerment to support not only healthy members, but also productive and thriving organizations. To this end, we are pleased to offer the following types of wellness programs on a wide variety of topics to our clients at no additional cost:

  • Individual general health risk assessments with aggregated group analysis
  • Onsite screening clinics
  • Smoking cessation programs
  • Education seminars on a wide variety of health topics
  • Annual reviews of aggregate drug utilization, including therapeutic profiling plus customized recommendations

Profile Plus Personal Health Assessment

is the MHCSI Personal Health Assessment Program that provides confidential individual health assessments to members of group benefit programs. In addition, provides a consolidated report to the plan sponsor or employer of their group’s overall health status.

The purpose of this program is to provide individuals with a health assessment service that gives them the knowledge and resources to make healthy lifestyle choices. This program also gives organizations the insight and measurements necessary to manage corporate health strategy.

Confidentiality of individual health data is of the utmost importance. All survey data is stored in a secure environment. No personal data will ever be made available to anyone other than the individual. Plan sponsor/employer reports are compiled from non-identifying data in a composite format. This allows the plan sponsor/employer to identify the best organizational health strategies targeted at improving overall employee well-being.

Awareness Gets You Started

There are two easy ways to access . We offer clinics run by qualified health care professionals at your place of business, as well as the convenience of a self-directed web-based assessment from our secure website. These quick and easy health surveys take about 20 minutes to complete.

Health care professionals will take your blood pressure, glucose and cholesterol measurements using simple tests during the on site clinic. They will also record your height and weight. If you complete on the secure website, it is necessary to “know your numbers” for these measures before you begin. Your doctor or pharmacist can assist with this.

Knowledge To Make The Right Choice

There are many lifestyle factors that may be affecting your health; diet, alcohol intake, stress, smoking, exercise and many others. The survey will ask you about these areas of your lifestyle and more. Once you have completed your assessment you will receive a personal health report which includes an overall wellness score, information about your health risks and personal risk reduction strategies. This report is ideal to discuss with your primary care providers and use as part of a health goal diary. Once you complete your first general health assessment, we suggest you re-take the survey annually to track your progress over time.

Power To Decide

The power is in knowing what your healthy habits already are, and what things you still need to work on over time. With the information you now have from your personal health assessment report you are able to make smart choices about your health.

Manage Your Health

Managing your own health doesn’t mean you have to do it alone. There is a supportive team ready to help. is designed so you can manage your health in combination with programs offered by your plan sponsor/ employer and your health care professionals.

Balance Your Life

Family, health, work, and well-being. These are the things most of us need to consider to maintain a good balance in our lives. Taking the MHCSI Personal Health Assessment can help make it easier to find that balance.

Five Reasons Why

  1. To create awareness of individual and organizational health status.
  2. To set an appropriate plan of action to improve individual and group health.
  3. To deliver the right programs that provide a favourable return on your investment in employee health.
  4. To measure the success of your organizational health strategy over time.
  5. Because good health is smart business.

This confidential and comprehensive program is FREE to MHCSI group benefit clients and available at great rates for all others.

Drug Utilization Review

MHCSI will provide a review of claims usage annually with recommendations.

Non Formulary Request (NFR) Turnaround
Within 2 business days of receipt of complete information.

Manual Claims Processing
Manual claims are processed within 5 business days in-house and forwarded to members by mail.

Service Area Network
Members who work or live within a 20 km radius of a Preferred Provider pharmacy location or participating independent are considered within our service area network.

New or Replacement Cards
MHCSI produces the member Pharmacy Benefit Cards and Lawtons Group discount cards in-house weekly and can produce as needed.

Education Sessions
On-site education sessions will be coordinated by MHCSI upon request, and with reasonable notice.

Customer Service
MHCSI has a Toll Free bilingual line (1-888-686-6427) as well as our (902)481-7112 direct number. Hours of operation are Monday to Friday 8:00 a.m. to 5:00 p.m., with voice message return on ‘same day within 2 hours’ or next business day for calls placed after hours.

Eligibility file maintenance is done either by email, electronic file,fax, or through our Web Admin site. (Typically the TPA will send either fax, email or electronic file before the end of the month with changes effective on the first of the following month. Emails, faxes are stamped received and handled by next business day. Changes through the Web Admin site are effective next day.

Small, Medium or Large Sized Companies

Our unique drug benefits plan is flexible enough to deliver on our promise of cost effective drug benefits – without ever sacrificing plan quality or service.

Here is a list of the industries we currently service:

  • Retail Grocery, Pharmacy
  • Health Care Sector
  • Transportation & Trucking
  • Manufacturing
  • Trade Unions
  • Multi Unit Corporations
  • Information Technology Sector
  • Car & Vehicle Dealerships
  • Suppliers
  • Call Centers
  • Municipalities
  • Small Business (Health Spending Accounts)
  • Financial Services
  • Real Estate
  • Entertainment
  • Distributors

We provide Drug benefit Services to employee groups ranging in size from 1 employee (health spending account) to over 34,000.

The information in this article was current at 06 Dec 2011

Keywords: Drug Benefits, Pharmacy Benefit

Contact Managed Health Care Services


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