ConvergaHealth - Specialty Benefit Management

ConvergaHealth is the leader in Specialty Benefit Management. ConvergaHealth was formed by a team of dedicated individuals that have an extensive background in home and alternate-site health care. This team is committed to offering a fresh approach to solving the needs of employer groups that are searching for innovative ways to control specialty medication spending.

The Medical Benefit is generally defined as prescription drugs administered in the home, outpatient clinic, or physician office and paid for under a beneficiary’s medical benefit plan. Unlike prescription drugs filled at a retail pharmacy and covered by a pharmacy benefit plan, this medical pharmacy segment of the overall healthcare space is often paper-based and extremely labor-intensive. And most importantly, it is plagued with significant inefficiencies that result in imprecise pricing, excessive reimbursements and overpayments, and insufficient prior authorization controls. Further complicating this situation is the "pipeline" of new specialty medications. Many of these medications while covered under traditional pharmacy benefit plans, require clinical monitoring and oversight (typically handled and billed under the medical benefit). ConvergaHealth provides an integrated approach that manages specialty medications under one benefit - the SPECIALTY BENEFIT! The result is improved clincial monitoring and patient/employee satisfaction and measurable cost savings for the employer.