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Pharmacy Management

Our range of pharmacy management services are designed to enhance the clinical gaps of government sponsored healthcare agencies.

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Our value helps stabilize the foundation of your program and improves beneficiary care

The healthcare landscape is constantly changing. Government sponsored healthcare programs need an independent, objective clinical partner, powered by compliant technologies, to help them stand strong against the financial and regulatory waves of the future.

Over 6 million pharmacy prior authorizations completed in under 24 hours

We deliver targeted support across multiple areas of pharmacy management


Establish and maintain appropriate pharmacy spend through increased oversight.

Setting Goals

Identify your fiscal and operational dependencies and ensure necessary separation of duties to drive objectivity and maximize value.

Clinical Criteria

Reinforce appropriate utilization with current clinical guidelines and standards of practice.


Clinical Advisory Services

Having a dedicated team of clinicians by your side enables you to confidently manage healthcare industry trends, regulation compliance and relationships within your provider and member community.

Kepro delivers:

  • Improved healthcare outcomes through standardized, vetted clinical criteria for both prior authorization requests and retrospective drug utilization reviews
  • Recaptured resources on your team through our administrative and clinical support for pharmaceutical research and data analysis
  • Increased accuracy of program assessments based on industry benchmarking
  • Greater awareness of solutions to solve the challenges of your program
  • Proven clinical knowledge base from a dedicated staff of pharmacists, nurses and pharmacy technicians

Drug Utilization Review

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.


We make data accessible by combining data from disparate systems to help you ensure appropriate and consistent care for your members.


Our criteria set is flexible, allowing us to be responsive to the specific needs of your program.

Actionable Reporting

We deliver reports that highlight gaps, opportunities and trends, so you have all the information necessary to make more informed decisions.


We allow programs to build an information-rich, non-confrontational dialogue with providers to enhance quality of care.

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



Automated Prior Authorization

As drug regimens become more complex, risky and expensive than ever, it’s crucial that pharmacy programs adopt smarter Prior Authorization (PA) systems. A fully-automated PA system allows you to quickly and objectively verify appropriate utilization — saving you time and money.

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.


Because the system is fully-automated, every determination is made objectively, based solely on the available data and configured criteria in the system.


RxPert® adjudicated more than 6 million requests in 2019 with average turnaround times of half a second across our client base.

Ongoing Review

RxPert reviews each potential dispensing of a medication to ensure the patient continues to meet criteria.

Cost Savings

Proven return on investment studies illustrate millions of dollars saved annually without risking patient health.


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
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Our 360-Degree Approach to Care Management

Utilization Management

Providing the right patients with the right care in the right setting — every time.

Case Management

Identifying and improving outcomes for high-risk, high-cost beneficiaries.

Care Coordination

Leveraging cross-disciplinary insights to create a full-scope view of patient health.

Pharmacy Management

Increasing pharmacy efficiency, accountability and compliance with expert guidance.

Employee Assistance Program

Supporting employee wellness and productivity with comprehensive services.

Absence Management

Tracking and analyzing employee absences to identify trends and opportunities.

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