Medicare Part D Expertise

Evidence-Based Formulary Management with Transparent Oversight

At SevaRx, our P&T Committee plays a central role in shaping our Medicare Part D formulary. This multidisciplinary panel of physicians, pharmacists, and clinical experts meets regularly to evaluate the safety, efficacy, and therapeutic value of medications.

What We Do:

• Clinical Review of Drugs: We assess each drug using peer-reviewed literature, FDA guidance, and real-world evidence.
• Formulary Decisions: Products are added, removed, or tiered based on clinical merit and Medicare Part D requirements.
• Regulatory Alignment: All decisions comply with CMS guidelines and support safe, effective, and accessible coverage.
• Conflict-Free Oversight: Committee members are independent and free from financial conflicts of interest

Personalized Coverage Decisions for Complex Needs

When a medication falls outside standard formulary coverage, SevaRx offers a robust Medical Necessity Review process to evaluate individual member requests.

How It Works:

• Case-by-Case Evaluation: Licensed clinicians review member-specific documentation, including prescriber notes and medical history.
• Timely Decisions: We meet CMS-mandated turnaround times for standard and expedited requests.
• Transparent Criteria: Coverage decisions are based on clinical guidelines, FDA labeling, and CMS policy, not arbitrary restrictions.
• Appeals Support: Members and providers receive clear communication and guidance on next steps if coverage is denied.

What We Do:

• Clinical Review of Drugs: We assess each drug using peer-reviewed literature, FDA guidance, and real-world evidence.
• Formulary Decisions: Products are added, removed, or tiered based on clinical merit and Medicare Part D requirements.
• Regulatory Alignment: All decisions comply with CMS guidelines and support safe, effective, and accessible coverage.
• Conflict-Free Oversight: Committee members are independent and free from financial conflicts of interest