Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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. Page 2 of 4 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