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

Piggy Bank

Retail Savings

Automated detection and notification trims excess cost from pharmacy spend. Instant data collection pinpoints cost reductions and captures savings at first fill.

3D Structure

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.

Circuit Board

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.

Graduation Cap

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┬ánational 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

Want to capture savings at first fill? Have access to best-in-class pharmaceutical management tools? Customize patient-specific formularies?