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The hierarchy of the Rx benefits management structure is as follows:
  • Payer Tier: Global responsibility for Financial and Management Data.
  • Carrier Tier: Member segmented per Specialty, or Managed Care specifics.
  • Plan Tier: Pricing, reimbursement, and adjudication concerning the Group tier.
  • Group Tier: Members strategically segmented per eligibility, exclusion, etc.
  • Member Tier: The active (and non-active) cardholder and his/her dependents.

    Unique, flexible plan edits may be incorporated into the PC Pros architecture at any point requested by the customer. In this way, the customer defines their unique prescription benefits management needs which are then met by the PC Pros system.