Our cost-of-care programs are about saving money and setting healthy trends. How do we manage a client’s cost of care? We find ways to make prescription use affordable. We promote generics and over-the-counter medications. We effectively manage our drug list. We keep an eye on the medications our members use. And we monitor a member’s prescription use as a whole – to help them achieve better health.
We strive to maximize every cent spent on medications – and that helps your bottom line. When medications are less expensive, research shows the individuals taking them are usually more compliant. That leads to healthier employees, reduced medical costs, higher productivity and lower absenteeism.
How do we do this? We combine our clinical and cost-of-care messages into one communication to reduce member abrasion and make a stronger impact. Members don’t receive multiple letters focused on individual clinical and cost-of-care programs. And, to help ensure coordination of care and compliance, physicians also receive a consolidated communication with similar messages.
Drug List Management
We’re leading the health care industry in the way we choose covered drugs. We analyze the strongest clinical drug studies – and see how drugs work in real life for our members. We believe the right drugs to cover are the ones that do the best job for members, and reduce the total cost of care.
By looking at claims, we find opportunities for our members to save money by switching to lower cost drugs that are therapeutically equivalent to the medication originally prescribed. We send members personalized messages about medications that may reduce their costs – and we include specific cost savings.
Preferred Glucometer Program
We encourage members to use preferred blood glucose meters, which may help them save money on test strips. Through this voluntary program, members are offered a complimentary meter.
Drug Utilization Management
Standard Clinical Edits
Our standard point-of-service edits monitor drug list compliance, clinical appropriateness, medication safety, age, gender, duplicate claims, duplicate prescriptions, refill frequency, maximum dispensing limitations, and cost and quality inconsistency.
Enhanced Clinical Edits
These point-of-service edits encourage safe medication use, promote appropriate use, and help control drug spend. When necessary, we’ll help members find alternatives.
Members taking certain medications can get their prescription filled for a higher strength and split the tablets in half. By splitting tablets, copays are slashed by up to 50%.
Clinically Equivalent Medications
Some drug classes include medications that are just as effective as one another. When this is the case, our strategy is to cover the better value, lower cost drugs. Members may be able to save money on their medications. And this helps manage the overall cost of health care.