Pharmacy Management

Our Retrospective Drug Utilization Review (RDUR) solution is a comprehensive toolkit that includes expert clinical services, extensive system capabilities and robust data analysis to help you identify drug use trends and care gaps in your program.

Our RDUR solution empowers clients to discover usage trends in their member populations, adjust prescribing behavior through provider intervention and ensures appropriate formulary management’

Our RxExplorer® application collects and processes data from pharmacy and medical claims and compares these findings against our sophisticated therapeutic criteria. This produces an enhanced database for analysis, clinical review, and intervention.

Without the ability to gather information about program effectiveness, agencies risk increased pharmacy cost and decreased quality of care. Our RDUR solution allows you to identify potential therapy gaps and guide your provider population in healthier prescribing practices.

Kepro delivers:

• Greater visibility into the health of your pharmacy management program
• Deeper understanding of the effect of program activity on drug use trends
• Efficient, secure access to your pharmacy and medical claims data in a single tool
• Improved therapy management for population health
• Stronger relationships with your provider community

RxPert® is a fully-automated prior authorization adjudication system that receives medication coverage determination requests. RxPert® evaluates requests using all available pharmacy, medical and eligibility data, and returns results in a real-time, secure NCPDP P4 transaction — with no human interaction. In fact, response times average less than half a second.

RxPert® uses clinical expertise to make superior coverage decisions by leveraging secure, scalable technology. RxPert® has refined the PA process by:

• Reducing costs
• Improving consistency
• Allowing prescribers, dispensers, and agencies to eliminate hours previously spent on manual or partially-automated PA processes

By utilizing automated prior authorization processes, our clients can control appropriate therapy with auditable, consistent and objective rules.

Kepro delivers:

• An automated, manageable way to consistently and efficiently apply prior authorization criteria
• Rapid processing that enables complex and extensive edits that would be expensive to complete manually
• Minimized impact on providers, pharmacies and patients because edits are evaluated based on accessible data in the system instead of person-to-person interaction
• Proven success in seamlessly integrating with claims processing systems and third-party call centers across the country