Ask the Pharmacist: All About the Right Rx Program
August 12, 2025
By: Anna McGhee
Categories: Ask the Pharmacist
Tags: For Members, Prescription Drugs, Medications, Right Rx
Editor’s Note: Your health plan has collaborated with US-Rx Care for a number of years in delivering the Right Rx program for members. In this issue, Director of Pharmacy Anna McGhee discusses that collaboration and the benefits of the Right Rx program to our members.
Q: What is the Right Rx program?
A: Saint Alphonsus Health Plan and US-Rx Care have collaborated for several years on the Right Rx program. The program is designed to enhance the pharmacy benefit for you as well as minimize costs to you and the plan. In addition, through the Right Rx program we are able to proactively monitor compliance with CMS quality measures and can notify providers of any identified gaps, specifically involving prescription medications.
Q: How does Right Rx work?
A: The program consists of two primary components, the first of which is Therapy Alternative Recommendations.
US-Rx Care reviews current provider-prescribed medications to look for potential quality improvement and cost savings opportunities for medications that members – possibly yourself – are taking. The US-Rx Care team may contact your provider to advise them on medication alternatives. After careful review, your provider may approve these alternatives, after which a US-Rx Care representative will be in contact with you, to advise you of the alternative.
Q: Am I obligated to choose the alternative medication?
A: No. These recommendations are designed to save you money, and help you take advantage of doctor-approved, lower cost alternatives. You and your prescriber may ultimately decide that the alternative medication isn’t right for you, in which case you may continue with your previously prescribed medication.
Q: What is the other component of Right Rx?
A: Your health plan and providers are monitored and measured by The Centers for Medicare & Medicaid Services (CMS) for compliance with Star-rated quality measures to ensure they are working to your best, possible benefit. Some of these measures involve medication therapy. US-Rx Care can help close suspected gaps in care through monitoring and interventions related to these quality measures. US-Rx Care may make outreach to you or your provider to help improve and understand barriers related to medication adherence and safe medication use.
The Right Rx team not only brings awareness to any possible gaps, but also provides specific recommendations to help close those gaps.
Again, this is all done to ensure you’re receiving the best possible health care coverage.
Q: How can I contact US-Rx Care for member support?
You can contact US-Rx Care at 877-200-5533 for additional support.
