FORMULARY FINDINGS
This entity controls what is included on each client formulary.
The Employer
These are the four basic DISC styles.
Dominant, Inspiring, Cautious, Supportive.
This is the rejection code received when plan limitations have been exceeded.
Reject 76
RxIQ Enterprise Solutions
Commitments made by PBMs to clients regarding the achievement of specific outcomes, such as savings targets, formulary adherence, or member satisfaction levels.
Performance Guarantees
The only AffirmedRx Formulary starting 1/1/2025.
Choice Formulary
This DISC style represents the internal motivations that drive you the most.
Natural Style
Process requiring approval from the PBM before certain medications are covered, typically for high-cost or non-formulary drugs.
Prior Authorization
AffirmedRx Telephony Vendor
Aircall
A law which created rules and guidelines for health care coverage. It was signed by President Obama in 2010.
Affordable Care Act
This application houses our source of truth for current formulary and shows any updates that may have been made by the clinical team.
SharePoint
This determines whether an individual is task-oriented, or people oriented. Also known as the Priority Drive.
Compass Drive
This rejection code tells me the prescription is required to be filled at a specialty pharmacy.
SPP
This is the AffirmedRx PCA documentation system.
HealthCloud
This is a group of pharmacies that have contracted with a health plan or pharmacy benefit manager (PBM) to provide covered products and services to members.
Pharmacy Network
This sequence tells us the package size of a drug.
NDC (National Drug Code)
This DISC type describes people who have both Outgoing and Task-oriented traits
Dominant
A protocol where patients must try lower-cost medications before higher-cost alternatives are covered by insurance.
Step Therapy
Application used by members to help manage their own medications.
Pulse App
Discounts or refunds provided by pharmaceutical manufacturers to PBMs in exchange for preferred placement on formularies or increased utilization of their drugs.
Rebate
The Clinical Client Manager and Director of Formulary Strategy at AffirmedRx
Dr. Calla Vodoor
The DISC Model is based on this.
Range of Normal Behaviors
This is the name of our call center.
RxSense
This is the AffirmedRx VP of Clinical Product and Partnerships.
Dr. Fred Barton
Groupings of prescription medications within a formulary based on cost-share, such as generic, preferred brand, and non-preferred brand.
Tier Sets (Tiers)