Frequently Asked Questions

New Capabilities

• What new solutions does MacroHealth offer?
  • Full PBM/SPBM replacement/carve-out 

  • Medical specialty pharmacy benefit management 

  • Specialty medication benefit management  

  • Financially impactful pharmacy program optimization
• Which capabilities are now integrated into the MiX platform? 

  The MiX platform will now give Payers the ability to offer a provider search tool to members, delivering better member experiences with: 

  • Custom-fit datasets: Combine data from carrier provider directories, claims, provider quality ratings, and machine-readable files (MRFs) to deliver personalized results for members.    

  • Complex network arrangements: Unite supplemental, tiered, and carve-out networks into a seamless member experience, improving usability and engagement. 

  • Alternate care delivery: Customize search results to highlight alternate care options important to your organization, including on-site clinics, telemedicine providers, and specialty networks. 

Benefits for Payers and Health Market Partners

• How do these capabilities benefit Payers? 

  Payers gain increased visibility into partner performance, improved control over pharmacy spend, more precise out-of-area and out-of-network cost management, and tools that align benefit designs with steerage and tiering strategies. 

• How do these new capabilities benefit Health Market Partners? 

  With the addition of Pharmacy capabilities, MacroHealth can now support an entirely new segment of Health Market Partners. With our new pharmacy solutions, these partners now have a clear and valuable reason to join the MacroHealth ecosystem. 

  For existing Health Market Partners, these new capabilities open the door to broader cross-sell opportunities. By incorporating network and pharmacy solutions, Health Market Partners can expand the reach of their offerings to more plans and members across the marketplace. 

• How does MacroHealth support health plans? 

  Health plans can leverage one integrated platform to optimize their healthcare costs and connect to an ecosystem of vendors who are focused on delivering high-quality, affordable care to members. 

• How does MacroHealth support third-party administrators? 

  Third-party administrators (TPAs) can offer employer clients a sophisticated, data-driven experience through enhanced network performance, advanced analytics, and integrated transparency tools that support cost-efficient plan design, all without increasing operational complexity.  

• How does MacroHealth support brokers and consultants? 

  Brokers and consultants can use unified analytics tools to support smarter benefit design, streamline vendor selection, and provide their clients with transparent, member-facing tools that reinforce plan strategies.