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Walgreens Health Initiatives
Products and Services
Program title
Description
Savings
opportunity
Approximate
percent of
clients enrolled
in program*
Plan Design Options
340B Drug Program
Allows certain public health service and government-supported health centers or
covered entities to purchase outpatient medications from drug manufacturers at
significantly discounted prices.
High
<1%
Advantage90 ®
Allows members to obtain up to a 90-day supply of medications either by mail
or through any of more than 37,000 participating network retail pharmacies.
Provides added convenience to members and savings to the plan.
Low/Medium
54%
Consumer Choice Pharmacy
Designed with a pharmacy account (HRA-health reimbursement arrangement) and
deductible prior to a traditional coinsurance benefit applying.
Medium
<1%
Mail Service
Provides home delivery of prescriptions through mail service pharmacies located
in Tempe, Ariz.; Orlando, Fla.; and Portland, Ore.
Medium
87%
Medicare Part D
Supplemental Coordination
of Benefits (COB)
Allows clients to set up a secondary benefit to supplement a member’s Part D
drug benefit. The client adds value to his or her membership’s prescription benefit
by enhancing his or her prescription coverage using a secondary claim submission.
Low
<1%
Pharmacy Network
Preferred Network - Includes nearly 62,000 pharmacies including both wellknown national drugstore chains and independents.
Value-added
75%
Custom Network - Customizes a pharmacy network to better serve members by
surveying appropriate markets for additional network providers.
Value-added
25%
High
45%
Medium
<1%
Preferred Medication List
(three-tier formulary)
Encourages cost-effective medication utilization by offering a lower cost to
members on generics and preferred brand medications that have a higher
pharmacoeconomic value.
Preventive Drug List
Offers full coverage or a low copay for specific preventive medications before the
member meets his or her deductible.
*Data as of May 2007. Percentages based on client’s program eligibility.
Page 1 of 4
Program title
Description
Savings
opportunity
Approximate
percent of
clients enrolled
in program*
Utilization Management Programs
Medication Management
Clinical Prior Authorization
(CPA)
Encourages appropriate and cost-effective use of medications by allowing
coverage when certain conditions are met.
Medium
Medication Management
Step Care Therapy
Requires that one or more prerequisite medications must be tried first before a
“step therapy” medication will be covered, unless medical exception authorization
is received. Some drug classes include proton pump inhibitors (PPIs),
ACE-Inhibitors, and nonsedating antihistamines (NSAs).
High
Medication Therapy
Management (MTM) Medicare
and Commercial
Complies with standards set by the Centers for Medicare & Medicaid Services
(CMS) and is supported by a network of in-store pharmacists and other patient
interventions as well as a clinical call center. It aims to help patients understand
their medications, avoid inappropriate or potentially dangerous medications,
increase adherence, and optimize therapy.
High
Newly Developed
Specialty Pharmacy
For patients taking medications for complex health conditions. Specialty prior
authorizations are included on selected medications to ensure appropriate
utilization prior to dispensing. Patients receive education, adherence monitoring,
utilization management, and support.
Medium
99%
Voluntary Tablet Splitting
Program
Offers cost savings to the plan and members where a member cuts a tablet that
is double the strength in half to take the prescribed dose for select medications.
Medium
Newly Developed
Medium
90%
Value-added
13%
Low
23%
81%
Therapeutic Interchange Program
Informed Prescribing SM
Designed to help clients control medications expenditures while providing
enhanced patient care to their members. Dedicated, specially trained pharmacy
professionals communicate directly with physicians, while promoting generic and
formulary utilization to ensure that these goals are met.
Integrated Care Considerations
Health Outcomes Quarterly
Medical Trend Report
A detailed reporting package on medical claims utilization and financial
information.
MedMonitor ® (RDUR)
Integrates and monitors prescription and medical histories to help ensure
patients’ safe, appropriate medication therapy.
Disease Management and Wellness Programs
Healthful Living™
Care Management
A multifaceted offering designed to help improve self-management of costly
and prevalent chronic health conditions and create a win-win situation for plan
sponsors and members alike. This education is conducted through telephone
consultations, face-to-face counseling in select markets, and pharmacistphysician collaboration. The wellness-focused offerings help healthy members
stay well and manage the risk factors for disease. Programs cover diabetes,
respiratory (asthma and chronic obstructive pulmonary disease), smoking
cessation, and weight management.
Improved
Health Outcomes
11%
Healthful Living™
Comprehensive
Care Management
A program offered in collaboration with Matria® Healthcare that provides
comprehensive patient-focused education and support targeted at producing
improved outcomes. It is delivered via multi-condition assessments, health and
wellness personalized telephone counseling, and disease management with an
extensive audio support library that offers participating members comprehensive
care and health education. Programs cover the following areas: cardiac, diabetes,
low back pain, and respiratory care management. Clients participating in at least
one of those programs can sign up at an additional cost for others on topics like
cancer care, depression, low back pain, pregnancy, and weight management.
Improved
Health Outcomes
<1%
*Data as of May 2007. Percentages based on client’s program eligibility.
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Program title
Description
Savings
opportunity
Approximate
percent of
clients enrolled
in program*
Disease Management and Wellness Programs
Healthful Living™
On-site Learning
An interactive program aimed at improving members’ awareness of their health
conditions and wellness-related behaviors, proper monitoring, and treatment
options. It can enhance their self-management behavior by increasing their
confidence and knowledge of their condition or potential conditions that they may
be at risk for in the future. Members have the opportunity to interact with and ask
questions to the pharmacist who delivers an informative seminar.
Improved
Health Outcomes
Newly Developed
Healthful Living™
Risk Assessments
The following three programs are provided in collaboration with Quest
Improved
Diagnostics®:
Health Outcomes
1.Offers members a comprehensive health risk assessment (HRA) questionnaire, venous blood draw with more than 30 laboratory based diagnostic tests, and
biometric measures (height, weight, and blood pressure) to evaluate modifiable
health risks with the greatest impact on health and healthcare costs.
2.Offers members a comprehensive HRA questionnaire and blood screenings that
measure cholesterol levels and glucose to assess risks for cardiovascular
disease and diabetes.
3.Offers a value-driven, economical HRA questionnaire.
Newly Developed
Patient Safety Initiative
Concurrent Drug Utilization
Review (CDUR)
Applies age, interaction, early refill, and other safety edits at the point of sale.
Information is based upon clinical data and prescribing recommendations as
represented in the package labeling.
Low
100%
Medium
91%
Quality Improvement Program
E-prescribing
Seeks to optimize prescription utilization including generic and formulary use, and
reduce medication errors through the use of technology.
Educational Resources and Tools
Health Briefs
Informative communication pieces available to registered members at mywhi.com
that are designed to educate members about health conditions.
Value-added
Mortar & Pestle
A weekly electronic publication designed to provide clients with recent
medication-related news, including warnings and updates on brand name as
well as generic medications and new medical products collected from various
renowned industry resources.
Value-added
NA
mywhi.com
A personalized web site providing members with information and tools
regarding benefits, healthcare information, and services. Members can confirm
their prescription coverage and copays, find lower cost alternatives, and review
their medication history.
Value-added
NA
Newsletter Article Library
Content that clients can include in their own newsletters to better encourage their
members to effectively utilize their benefit.
Value-added
NA
Rx Matters
A bimonthly newsletter that provides clients and consultants with news and
trends in healthcare and up-to-date information about Walgreens Health Initiatives
products and services.
Value-added
NA
RxPort Query Tool
Enables clients to run reports from current prescription claims data and report on
utilization and financial fields tied to a prescription claim.
Value-added
31%
Walgreens Health Initiatives
Trend Report
A comprehensive annual report showing overall Walgreens Health Initiatives trend,
generic utilization, and trend drivers.
Value-added
NA
*Data as of May 2007. Percentages based on client’s program eligibility.
Page 3 of 4
NA
Program title
Description
Savings
opportunity
Approximate
percent of
clients enrolled
in program*
Batch File Deductible
Accumulations
High-Deductible Health
Plan (HDHP)/Health Savings
Account (HSA) Support
Services
A file transfer protocol (FTP) batch file process to share and sync deductible
dollars between Walgreens Health Initiatives and a medical provider/third party
administrator (TPA).
Improved
Syncronization
of Deductible
Dollars/Financial
2%
Medicare Part D Retiree Drug
Subsidy
Medicare federal subsidy services include actuarial attestation services, notice of
creditable coverage creation and distribution, Centers for Medicare & Medicaid
Services (CMS) enrollment file updates, CMS cost report submissions, annual
reconciliations, and retiree drug subsidy (RDS) online application assistance.
High
16%
Real-Time Deductible
Accumulations
High-Deductible Health
Plan (HDHP)/Health Savings
Account (HAS) Support
Services
A real-time process that sends deductible updates from Walgreens Health
Initiatives processing system to a medical provider/third party administrator
(TPA) processing system and vice versa. Process ensures deductible updates are
shared in real-time when a prescription or medical claim processes. Both medical
provider/TPA and Walgreens Health Initiatives will be in sync as to the deductible
bucket dollars used up.
Improved
Syncronization
of Deductible
Dollars/Financial
Newly Developed
Support Services
For more information call 800-926-6779,
e-mail [email protected], or visit us at
WalgreensHealth.com/pbm
Brand names are the property of their respective owners.
*Data as of May 2007. Percentages based on client’s program eligibility.
Page 4 of 4
©2007 Walgreens Health Initiatives, Inc., a wholly owned
subsidiary of Walgreen Co. All rights reserved. PBM6010-0407