Program Cost Containment and Quality of Care Strategies

Southeastern Consultants, Inc. has provides consulting, data analysis and program evaluation services for utilization and program management that include the following activities:

  • Maximum Allowable Cost (MAC) list
  • Prospective DUR system edits
  • Quantity and days supply policy limits
  • Audit program procedure development
  • Prior approval programs
  • Lock–in programs
  • Rebate management
  • Third-party pharmacy claim liability determination
  • Prescription limit and co-pay policies
  • Evaluation of supplemental rebate programs
  • Evaluation of pharmaceutical reimbursement rates
  • Auditing of claims payments and system edits
  • Development of innovative provider incentive and payment models including pay for performance, shared savings, medication therapy management (MTM) programs and others