Pharmacy Benefit Program Can Be Tailored to Each Customer’s Needs, Using Evidence-Based Clinical and Technological Innovations
IRVINE, Calif.--(BUSINESS WIRE)-- Prescription Solutions, a leading pharmacy benefit management organization and a UnitedHealth Group company, has launched Clinical VantageSM, a suite of clinical programs that enables clients to create specialized solutions to meet their particular needs to improve the health and well-being of members.
More than 100 evidence-based clinical programs and technological innovations, covering a wide range of therapeutic categories and populations, are gathered under the Clinical VantageSM umbrella. Prescription Solutions clients have the flexibility to select single or multiple program types that best meet their needs or goals to reduce pharmacy costs while improving health care outcomes for their members.
“Rising costs across the health care spectrum makes the role of pharmacy benefit managers more important in ensuring that patients have access to the prescription treatments they need, at a cost that is sustainable for employers and payers,” said Joseph Addiego, M.D., chief medical officer, Prescription Solutions. “Many companies believe their pharmacy benefits program can be improved, but often don’t know how to go about making a change. Clinical VantageSM is designed to address customers’ specific needs as they adapt to a changing health care landscape.”
The Clinical VantageSM approach has four distinct uses – creating customized solutions, improving quality and safety, maximizing savings, achieving optimal health – that individually provide clients with specialized solutions or, taken together, help clients achieve clinical and economic goals.
Creating Customized Solutions: A Comprehensive, Strategic Approach
Prescription Solutions looks at the pharmacy benefit management process from a clinical standpoint first and foremost. Its expert clinical team has established leadership in clinically focused, scientific, evidence-based pharmacy and medical management.
The company conducts comprehensive reviews of client pharmacy utilization data to identify opportunities to reach out to prescribers and patients – with educational mailings or personalized outreach via telephone by a registered nurse or pharmacist – and help them improve their quality of care while still providing a cost-effective pharmacy benefit.
Improving Quality and Safety: Disease-Specific, Drug Interaction and Medication Therapy Management (MTM) Programs
Clinical VantageSM programs promote proper medication use, monitor medication utilization and help prevent drug misuse and overuse. Prescription Solutions offers many disease-specific clinical programs that identify gaps in therapy to reduce morbidity, mortality and overall health care costs. Many of these programs are based on NCQA’s HEDIS® measures and are part of the company’s quality improvement initiatives. For example, Prescription Solutions’ Asthma Therapy Optimization program for one large health plan client resulted in more than 73% of patients improving their asthma symptoms and reducing asthma-related ER visits and hospital admissions, saving the client an average of $335 per member in pharmacy and medical costs during the year.
MTM programs are a key component of Clinical VantageSM, helping to prevent complications caused by adverse drug reactions, poor medication adherence or other therapeutic deficiency in a number of chronic and high-impact disease states. For example, 70 percent to 82 percent of clients’ members receiving refill reminder calls as part of an MTM program for select chronic medications refilled their prescriptions leading to improved medication adherence. A separate internal study indicated that among the patients taking antidepressant medications, those who were adherent to their medication therapy had $2,361 lower annual total health care expenditures compared to non-adherent patients.
Other quality and safety-related Clinical VantageSM programs among clients include:
Maximizing Savings: Clinically Managing Drug Formularies while Promoting Generics and Mail Order
Prescription Solutions offers effective tools to clinically manage client drug formularies to reduce medication costs. Using evidence-based analyses, Prescription Solutions continuously reviews therapeutic advantages and disadvantages of medications before recommending any formulary changes to clients. With an arsenal of formulary management tools, which include formulary education initiatives, pipeline drug forecast and utilization management programs; Prescription Solutions proactively promotes generics and other lower-cost drug therapies.
Generic drug use has saved the health care system an estimated $734 billion over the past decade (IMS Health, 2009). Prescription Solutions is an industry leader in driving clinically appropriate use of generic medications, and its utilization rate for generic medications is among the highest in the industry. For example, one client using Prescription Solutions’ Generic Medication Utilization Programs experienced a 28 percentage point jump – from 45 percent to 73 percent – in its generic utilization rate over five years.
Patients also benefit as prescription drug plan participants typically save $20 to more than $60 per prescription when switching from a brand to a generic drug.
Prescription Solutions’ award-winning and nationally accredited mail service pharmacy offers patients convenience, cost-effectiveness and safety. Its state-of-the-art mail service facilities offer 24/7 services and provide precise processing of high volumes of prescriptions, with fulfillment turnaround of less than two days and greater than 99.9 percent accuracy.
Achieving Optimal Health: Specialty Pharmacy and Disease Therapy Management
Specialty pharmacy is the fastest-growing area of health care, projected to be nearly 25 percent of the nation’s total drug spend in 2010, or approximately $110 billion. Prescription Solutions Clinical VantageSM specialty pharmacy programs help clients manage the rising cost of expensive specialty medications (which also pose medication adherence difficulties for many patients) by delivering high-touch service and advanced care management strategies. These include customer support, case review, comprehensive member education and guidance, member adherence support and prior authorization.
In addition, Disease Therapy Management (DTM) programs provide personal care to specialty pharmacy patients to help improve quality of life, promote self-management, increase medication adherence and reduce overall health care costs. This is achieved through services such as personalized telephone consultations with program participants, development of patient-specific care plans, ongoing care management services based on member needs, notification and communication with health care providers and more.
A recent Prescription Solutions study showed a 33.6 percent reduction in multiple sclerosis (MS) relapses in 283 patients who completed the MS/DTM program, which could potentially save an estimated $173,246 in medical costs due to relapses (based on $13,026/MS relapse from a previously published analysis), or $612 per patient participating in the program. Established research has shown that insured patients with MS incur two to three times more health-related expenses than insured patients who do not suffer from MS.
To learn more about Clinical VantageSM, visit www.prescriptionsolutions.com.
About Prescription Solutions
Prescription Solutions is an innovative pharmacy benefit management company managing the prescription drug benefit of commercial, Medicare and other governmental health plans, as well as those of employers and unions. A UnitedHealth Group company, Prescription Solutions serves customers through a national network of 64,000 community pharmacies and state-of-the-art mail service pharmacies in Carlsbad, Calif., and Overland Park, Kan., both of which have earned the prestigious Verified Internet Pharmacy Practice Sites™ (VIPPS®) accreditation by the National Association of Boards of Pharmacy® (NABP®). The company won two Silver Awards for URAC’s Best Practices for Consumer Empowerment and Protection Awards – Geriatric RxMonitor Program (2008) and the Drug Interaction Alert Program (2009). Additional information can be found at www.prescriptionsolutions.com.
About UnitedHealth Group
UnitedHealth Group (NYSE:UNH) is a diversified health and well-being company dedicated to making health care work better. Headquartered in Minneapolis, Minn., UnitedHealth Group offers a broad spectrum of products and services through six operating businesses: UnitedHealthcare, Ovations, AmeriChoice, OptumHealth, Ingenix, and Prescription Solutions. Through its family of businesses, UnitedHealth Group serves more than 75 million individuals worldwide.
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David Himmel, 714-226-3772
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INDUSTRY KEYWORDS: Technology Data Management Software Health Pharmaceutical Managed Care