The Gold Standard in Formulary Management

RxFlex is a web-based, enterprise formulary management solution designed from the ground up to manage formularies for all lines of business — efficiently and intuitively. The Gold Standard in formulary management, RxFlex is relied upon by some of the most technology-forward health plans and PBMs in the country.

Manage Formularies and Utilization Management Edits Efficiently

Create and maintain formularies and utilization management edits manually or leverage RxFlex’s powerful auto-rules engine, which drives an 80% reduction in weekly maintenance. RxFlex was designed replace manual, inefficient processes with capabilities you can trust. For all lines of business, across clients, never make the same change twice.

  • Create new formularies, copy existing ones, or make bulk changes to multiple formularies in just a few clicks
  • Create and manage benefit level coverage lists, clinical programs, exclusion and Part D submission files
  • Intuitively manage auto-tiering rules for new to market drugs, line extensions, and new NDCs
  • Modify formularies by drug attribute (e.g. GPI, GCN, RxCUI, NDC, multi-source)
  • Supports multiple 3rd party drug data sources (e.g. First DataBank, Medispan, NLM)
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Single Source of Truth

RxFlex is your front end to benefit management your organizational source of truth. By eliminating the need to enter and store identical information across multiple (typically antiquated) systems, Adaptive can ensure that there is no discrepancy across platforms or with downstream stakeholders. Adaptive products are built around the way you do business, so that you can enter data once and let us take care of the rest.

  • Claims Integration: Adaptive is the only formulary management provider able to ensure complete data consistency through direct integration with claims adjudication systems. RxFlex currently interfaces with FirstRx, Laker, RxClaim, and RxNova.
  • CMS/Medicare Submissions: whether creating new formularies or complying with CMS monthly maintenance requirements, RxFlex will get you there efficiently and ensure that your Medicare formularies are approved the first time.
  • Manage and Publish Member Documents: customize and generate marketing documents, and effectively communicate benefits to your clients and members.
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CMS Validation (Medicare and Marketplace)

Whether creating new Medicare or Marketplace formularies or complying with the monthly CMS formulary maintenance process, RxFlex has you covered. With powerful validation reporting, we identify potential failures before you send files to CMS — ensuring that your formularies are approved the first time.

Tickets, Tracking, and Accountability

Everything in RxFlex is centered around the concept of a “ticket”. Each ticket is a unique change request that can be issued, reviewed, and enacted based on carefully defined business processes. RxFlex enables you to manage workload assignment, track the status of internal and external requests, and access robust change history for conducting audits.

Track SLAs

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Configurable, Role-Based Workflows

RxFlex is designed to give clients complete control over accessibility and workflows

  • After defining distinct user roles based on common use cases, function, or line of business, each user will have a streamlined experience with RxFlex. Our rules engine and smartform library ensure that users see only what they need to see, when they need to see it
  • RxFlex will mirror your existing internal change approval processes, empowering managers to prevent mistakes from going live. Our ticket-based workflow offers comprehensive change reporting necessary to track who made each change and when
     

Modern Analytics and Dashboards

Powerful reporting and analytics will empower users to uncover inconsistencies and identify opportunities to reduce drug spend. Quickly pivot, analyze and compare coverage and utilization management edits across your organization, and compare them to benchmark plans to ensure that you are maintaining an appropriate standard of care.

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