What We Do

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nirvanaspecialty service

  1. nirvanaRxCloud™ Services: National full-service pharmacy benefit management services leveraging the Collaborative PBM Cloud™ platform to provide administrative, clinical and value-added services with unmatched regulatory system-driven compliance and transparency. We deliver fully integrated PBM services that reduce overall pharmacy costs, reduce avoidable drug-impacted medical costs, and enhance patient health. With nirvanaRxCloud™, RxAdvance has created an innovative PBM paradigm that offers:
    1. Pharmacy cost savings through:
      • Optimal benefit plan design and modeling services leveraging IntelligentDUR360°Gateway™
      • Maximization of operational efficiencies, which leads to lower administrative fees through the Collaborative PBM Cloud™ platform
      • Reduction of drug unit costs via competitively negotiated pharmacy network contracts and manufacturer rebate contracts
      • Promotion of untapped generics
      • Reduction of fraud, waste, and abuse (FW&A)
      • Transformation of specialty management from the current “Buy & Bill” model to a “Value-Based and Outcome-Driven” specialty management model
    2. Drug-impacted medical cost reduction and improved quality of life for patients through:
      • Medication adherence management (MAM)
      • Coverage gap prediction and prescription planning (CGP³)
      • Reduced adverse drug events (ADEs)
      • Integrated medication therapy management (MTM) with physician-led comprehensive medication reviews (CMR)
    3. Unmatched system-driven regulatory compliance through Collaborative PBM Cloud™, minimizing personnel involvement
    4. Care stakeholder collaboration through the IntelligentDUR360°Gateway™, enhancing communication between prescribers, pharmacists, patients, and plan sponsors’ clinical and pharmacy staff
    5. Patient mobile cloud services to engage members to make intelligent health and wellbeing decisions using the disease-driven Patient-Rx360oTM mobile cloud platform
    6. Complete operational visibility and transparency to plan sponsors, made possible through the Collaborative PBM Cloud™ platform
    7. Unprecedented user configurability, enabling:
      • Rapid implementation
      • Easy incorporation of ongoing business and market changes
      • Seamless adherence to compliance and regulatory changes
  2. nirvanaAccountableCare™ Services: A truly accountable partner to comprehensively manage the most unmanaged portion of managed care, while the payer or plan sponsor may choose to concurrently use their incumbent PBM. RxAdvance leverages nirvanaSmart to create an optimized, targeted care plan for patients, while offering a custom risk-sharing solution designed to incorporate a drug-impacted medical cost and chronic care risk management program. This comprehensive drug management solution enables collaboration amongst care continuum stakeholders to transform costs into shared savings for all parties by providing services that include:
    1. Risk stratification using advanced clinical clusters
    2. Comprehensive medication review & personalized care plan derivation
    3. SmartAdherenceTM management
    4. SmartHomeCarePlanTM management
    5. SmartHomeCareDeliveryTM management
    6. Risk & shared savings sanagement
  3. nirvanaSpecialty™ Services: The comprehensive specialty management service from RxAdvance that converts the “Buy & Bill” model to “Value-Based & Outcome-Driven” specialty management. Through a streamlined 10 step process, significant cost savings are delivered to plan sponsors. nirvanaSpecialty™ is designed to supplement a plan sponsor’s current PBM without disruption to the physician’s workflow and without requiring medical and pharmacy claims reconciliation or aggregation from the plan sponsor. The 10-step process includes:
    1. Specialty formulary management
    2. Specialty network management
    3. Physician education
    4. Utilization management
    5. Prior authorization management
    6. Procurement management
    7. Adjudication management
    8. Case and concurrent management
    9. Financial reconciliation
    10. Monitoring and measuring