CarelonRx is committed to providing access to high-quality prescription drugs and therapies backed by clinical evidence of improving health. In doing so, we encourage use of clinically superior drugs while minimizing use of drugs that are wasteful or unnecessary.  As health is improved, there is less use of other healthcare resources resulting in a total cost of care win for plan members and plan sponsors, alike.

How do we do it?

Our drug lists and clinical policies are based on the solid clinical bedrock of an independent review process undertaken by our team of pharmacists in conjunction with an independent pharmacy and therapeutics — or P&T — committee.

Working on behalf of plan members, this committee uses evidence-based medicine to purposefully evaluate clinical science and published literature. Safety, side effects, and tolerability are just a few of the factors taken into consideration as they strive to identify clinically-superior drugs that promote health.


Aligning clinical criteria and member care


We make sure the right treatments are used at the right time, and for members whose clinical characteristics are in alignment with the drug prescribed. This allows us to:

  • Maximize the clinical benefit for plan members.
  • Promote the use of clinically superior drugs and, conversely, minimize the use of clinically inferior drugs.
  • Minimize patient exposure to unnecessary health risk.
  • Reduce waste.
  • Lower total cost of care.

As a plan sponsor, you benefit from this process, too. Because a healthy workforce is a productive workforce. And getting the most from your prescription benefit spend, well, that’s just good business.

To help your plan members understand how they can learn more about the drug list and what medications are covered by your plan, please refer them to the Drug Lists page on

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