PHARMACY BENEFITS
MANAGEMENT
Putting the consumer at the center of the health care experience empowers them with more responsibility, but it must be coupled with strong support and information. Mail service pharmacy offers not only cost savings and convenience, but also programs that help members use medication appropriately, consistently, and safely. Here is an overview.
DS IN PHARMACY BENEFIT
MANAGEMENT
S P E C I A L S U P P L E M E N T
Mail Order Pharmacy is a
Boon for CDHC
By offering a robust mail service pharmacy option, consumer-directed health care plans provide a powerful support tool to their members. Here are six opportunities that your organization and employees can benefit from by utilizing a mail order service.
www.cdhcsolutionsmag.com I CDHC Solutions™ I March/April 2008 29
BY R.J. CORREIA, SENIOR VICE PRESIDENT OF MAIL
SERVICE OPERATIONS AND SPECIALTY AT
PRESCRIPTION SOLUTIONS
Pharmacy costs are arguably one of the most important components of consumer-directed health care. A significant and growing part of health care expenses, they are ripe for innovation and consumer involvement.
It may be some time before consumers truly get to direct their health care, but they can take some steps to save money and increase safety with some medications, and employers are in the position to make significant changes to their pharmacy benefit management to help their business while looking out for their employees.
Here are perspectives from some leaders in the field.
1. Cost Savings can be Significant
When members receive their medications for chronic conditions by mail, it saves money for both the consumer and the plan. Automated dispensing and fulfillment, high-volume purchasing, and operating efficiencies all contribute to making mail order more affordable than traditional means.
Studies by the Pharmaceutical Care Management Association have shown that mail order drug costs are reduced an average of 27% below the average cash price customers would pay at a retail pharmacy for brand name medications.
The savings are even greater for generics: 53% below cash prices at retail. Plus, many plans offer incentives if members obtain a 90-day supply vs. a 30-day supply by mail order. As an extra savings bonus, some mail order pharmacies offer substantial savings on over-the-counter medications and even medical supplies, such as those needed by diabetics for insulin injections. When consumers are paying out-of-pocket, these savings are especially welcome.
2. Increased Safety Precautions
A little-known benefit of a pharmacy benefit manager (PBM) mail order program is the additional safety precautions that it provides. People frequently take more than one medication at a time, putting them at risk for a potential adverse drug reaction.
Because PBM mail order pharmacists have access to members’ prescription drug records Through the management system, regardless of the pharmacy at which they may have been filled in the past, the pharmacist can spot these potential interactions and intervene, averting a potential bout of illness or even hospitalization. This does not happen when a consumer fills a prescription in person.
3. Personal Support and Help With Compliance
Specialty pharmacy drugs—expensive,complicated medications that are usually administered by injection—are the fastest growing category of pharmaceuticals. People taking these drugs for illnesses such as cancer, arthritis, and multiple sclerosis must adhere to complex treatment programs. These regimens, combined with physical, social, and even financial complications resulting from patients’ illnesses, can interfere with their ability to stay compliant and receive the health benefits these expensive drugs provide.
Through mail order pharmacy, members can receive the personal support of pharmacists and care managers who monitor their treatment plan and help educate them on their disease state. The care team counsels the patient and family by phone about potential side effects and how to manage them, as well as finds sources of support for other life and health situations.
A recent study by Prescription Solutions examined patients in five disease states who were receiving specialty pharmaceuticals by mail. The study found that compliance was greater with four out of the five disease states when patients used mail order over traditional methods. Compliance also increased in Prescription Solutions’ Disease Therapy Management (DTM), a care management program for patients taking specialty pharmaceuticals for multiple sclerosis, rheumatoid arthritis, or hepatitis C.
For example, multiple sclerosis patients who were not in a DTM program were more likely to stop taking their medications, with a discontinuation rate of 4 to 25%. In contrast, no DTM program participants discontinued their medication during the five-month post-study period.
4. Convenience and Privacy
A fourth reason that mail order is an especially attractive option is its timesaving convenience. It’s
If members have questions, a licensed pharmacist is available 24 hours a day, seven days a week. Many mail order members find that they prefer the confidentiality and privacy of a telephone consultation versus standing in line to speak with a pharmacist at a busy retail pharmacy.
5. Automated Checks Promote Accuracy
By using advanced computer technology, mail order pharmacies are able to help reduce human errors. Orders undergo rigorous safety checks in fulfillment accuracy before prescriptions are sent to the member. The most advanced facilities are able to process millions of prescriptions annually with a dispensing accuracy of 99.99%.
6. Accreditation is Reassurance for Online Safety
Proper accreditation reassures consumers that their medication is safe and accurate. Ordering prescription drugs online can be problematic unless safeguards are in place to ensure that the prescriptions are being filled by a reputable pharmacy. Pharmacies with the Verified Internet Pharmacy Practice Sites™ (VIPPS) accreditation have completed a rigorous evaluation of their safety practices in online pharmacy fulfillment.
The FDA has specifically cited VIPPS’ role in certifying websites that meet industry standards so that consumers can minimize the risks of buying poor quality drugs from disreputable sources. The VIPPS seal attests that the mail order pharmacy is properly licensed and has met a precise criteria review that considers patient confidentiality, security of prescriptions, a quality assurance program, and patient-pharmacist consultation.
Conclusion
A qualified mail order pharmacy, delivered through a clinically-driven PBM, offers convenience, cost savings, and programs that support improved consumer compliance, safe use of prescription drugs, and better health outcomes.
A mail order pharmacy also offers employers employee education programs, refill reminders, and safety programs. Choosing a health insurance plan that offers a mail order pharmacy option and utilizing its various pharmacy support programs will give you the satisfaction of providing a valuable resource for your employees, and one that empowers them to make smart health care purchasing decisions.
Randell J. “R.J.” Correia, Pharm.D., leads the mail service operations for Prescription Solutions, a PBM that manages the drug benefit of commercial, Medicare, and governmental health plans, as well as employers,union trusts, and third-party administrators. It has a national network of 60,000 community pharmacies and was named #1 mail order pharmacy for customer service and convenience in the 2007 WilsonRx® Pharmacy satisfaction survey. For information, call 888.398.5189, or visit www.rxsolutions.com.
Top 10 Features for Best Practices in Mail Order Pharmacies
1. State-of-the art facilities with new technology and centralized fulfillment and distribution
systems that deliver maximum cost efficiencies and savings, as well as added safety features.
2. Employee access to licensed pharmacists and customer service 24/7, 365 days a year.
3. The ability to manage prior authorizations to ensure the appropriate use of specific drugs.
4. An expertise in specialty pharmacy, and the support of pharmacists and care managers to monitor compliance for specialty pharmacy drugs.
5. Member education programs that promote compliance.
6. The ability to link medical and pharmacy benefits so that members’ accounts can be debited quickly and accurately.
7. A robust formulary managed with a clinically-based (versus solely cost-based) perspective.
8. A comprehensive generic substitution program.
9. Accreditation from Verified Internet Pharmacy Practice Sites™ (VIPPS), which attests to the quality and safety of online pharmacy services.
10. An excellent reputation and verified satisfaction from its plan sponsor customers.
TRENDS IN PHARMACY BENEFIT MANAGEMENT SOLUTIONS • SPECIAL SUPPLEMENT
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