SunriseRx Retail Pharmacy
Do you want your workers’ compensation pharmacy benefit manager to save you time, resources and money?
Cut cost from the formula with SunriseRx
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Retail Savings
Automated detection and notification trims excess cost from pharmacy spend. Instant data collection pinpoints cost reductions and captures savings at first fill.
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Customization
Global, multiple division and patient-specific formularies available. New injured workers added on the fly with Sunrise PriorityRx. Payer changes with the click of a button 24/7.
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Technology
Offers real-time interface and transaction monitoring. Provides instant access to medication details, retail drug card status and prescription status. Innovation provides most cost-effective program in industry.
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Education
Payer receives complete training. Sunstone, our SunriseRx web portal, provides robust claims, back-end management and reporting capabilities. Rx Intel reports and client-specific analysis highlight red flags and inefficiencies.
Benefits Overview
Retail Pharmacy Network
- Retail pharmacy network with 65,000 plus locations nationwide
- Includes all national chains and 20,000 independent locations
- Card and card-less programs available
- First fill capture program
- All invoicing through one provider
Mail Order/Home Delivery Services
- Wholly owned mail order pharmacy facility, leveraging purchasing power and driving down costs for payers
- Mail order services up to 90 day supply of medications
- Prescriptions shipped 2nd day delivery
- 24 hour toll free order line for claimants with interactive voice system
- Reduces transportation costs by the payer with home delivery for injured employees unable to drive or leave their homes
- No medication shipped without authorization
- No out-of-pocket expense to eligible third party
PriorityRx Point of Injury Program
- Prompt access to SunriseRx nationwide network of retail pharmacies when eligible injured party needs medication quickly
- Immediate authorization
- Fast fulfillment with no out-of-pocket charges to eligible injured party
- Capture the initial prescription at network discounts
- Scalable program offering client workflow customizations and medication plans
- Claimant enrollment on-site as well as on-line
- All invoicing from one source
Clinical Program
- Formulary management at client and claimant levels
- Point of sale review via real-time, offering customizable protocols and edits of medication prior to dispensing
- Utilization management, including pharmacotherapy case management, narcotic management and medication conversion programs
Sunstone Web Portal
- Online access to all claim data 24/7
- Instant access to medication details, retail drug card activation/suspension, prescription status and more
- Real-time interface, claim adjudication process and claimant-specific formulary customization
- Savings beyond drug discounts with robust Rx reporting, including client-specific analysis, high cost claims summary and predictive modeling based on historical claimant information
- Import claims data via electronic interface
Pricing and Processing
- New client savings average of 20-30% in the first year for retail program
- Cost plus pricing model creates greatest transparency for compound creams
- Contracts that work for payer and pharmacy
- Proprietary process saves clients as much as 75% on third party bills
- Retroactive processing interface (RPI) allows cost savings on direct-billed pharmacy invoices with contractual pricing on most bills, electronic submission and direct reimbursement to eligible party and pharmacy