Business Details
14 Years
experience
Proactive Pharmacy Benefit Management Solutions
At Medalist Rx, we are driven by a mission to transform pharmacy benefit management through proactive service and innovative technology. Our approach centers on anticipating member needs to deliver personalized solutions that prevent issues before they arise. With over two decades of combined experience in employee benefits and healthcare, our founders built a PBM that prioritizes integrity, transparency, and member care. We leverage real-time data analytics and API integrations to ensure accurate claims processing, cost savings, and seamless communication. Our dedicated team proactively identifies high-cost claim trends, securing copay assistance for 96% of eligible patients while maintaining an 86% success rate in transitioning members to cost-effective generics.By combining technical precision with human expertise, we provide 24/7 support to address benefit coverage, formulary questions, and prior authorizations. Our commitment extends beyond transactionswe strive to build trust through clear communication, thorough investigations of discrepancies, and advocacy for every member. Through continuous process refinement, we ensure accuracy in claims resolution and maintain industry-leading service standards. Our proactive model, encapsulated in 'Every Claim, Every Day,' reflects our dedication to reshaping the PBM landscape for the better.
Services
PBM Solutions
Claims Discrepancies
Copay Card Enrollment
Prescription Savings
Price Analysis
Price Transparency
Details
- Year established: 2012
Highlights and features
- We provide 24/7 customer support for pharmacy benefit inquiries
- Our team secures copay assistance for 96% of eligible patients
- We maintain an 86% success rate in transitioning members to generics
- We deliver real-time claims monitoring for immediate issue resolution
- We combine technical innovation with personalized member advocacy
Services
Proactive Claims Monitoring
Our proactive claims monitoring system continuously tracks prescription claims for anomalies. By analyzing real-time data, we identify potential discrepancies before they impact members. This approach ensures accurate reimbursement, prevents claim denials, and maintains compliance with regulatory standards.
Copay Assistance Programs
We help patients access critical medications through targeted copay assistance programs. Our team identifies eligibility based on claim patterns and proactively secures funding for 96% of qualified patients. This service reduces out-of-pocket costs while maintaining treatment continuity.
Generic Conversion Program
Our generic medication transition initiative identifies opportunities to switch patients to cost-effective alternatives. With a 86% success rate, this program maintains therapeutic quality while significantly reducing prescription expenses for both patients and payers.
24/7 Member Support
Our around-the-clock support team assists with benefit verification, formulary questions, and prior authorization requests. Available every day of the year, we provide immediate assistance through multiple channels including phone, email, and online portal access.
Price Transparency Solutions
We implement real-time price reporting systems that provide accurate out-of-pocket cost information for prescriptions. This enables informed decision-making for patients, providers, and payers while eliminating unexpected medication costs.
People
Mark Lewandowski
Co-Founder & Health Entrepreneur
Ph.D. holder with 20+ years of healthcare industry experience. Instrumental in developing Medalist Rx's proactive service model that revolutionized pharmacy benefit management practices.
Chris Deininger
President
Led strategic growth of Medalist Rx through innovative technology integration. Responsible for implementing the API systems that enable real-time claims monitoring and pharmacogenetics data exchange.
Paul Hagen
Co-Founder
Healthcare executive with extensive pharmacy management experience. Pioneered the member advocacy programs that achieve 96% copay assistance success rates for high-cost patients.
Questions
What specific PBM services do you offer?
We provide proactive claims monitoring, copay assistance programs, generic conversion initiatives, price transparency solutions, and 24/7 member support through our comprehensive PBM platform.
How do you help reduce prescription costs?
Our system proactively identifies cost-saving opportunities through real-time price analysis, generic substitution programs, and copay assistance eligibility screening to reduce medication expenses.
What makes your service different from other PBMs?
Our proactive approach identifies issues before they impact members, achieving 96% copay assistance success rates and 86% generic conversion success through predictive analytics and member advocacy.
Do you offer 24/7 customer support?
Yes, our member services center operates 24 hours a day, 7 days a week, with specialists available to assist with benefit questions, prior authorizations, and pharmacy processing issues.
How do you handle claims discrepancies?
Our dedicated claims resolution team uses proactive monitoring systems to detect and resolve discrepancies before they affect members, ensuring accurate processing through thorough investigations and transparent communication.
Can you assist with specialty medications?
Yes, our specialists help members navigate specialty pharmacy services, including benefit verification, prior authorization, and secure medication delivery coordination for complex treatment regimens.
