Clinical Integration

Clinical Programs

We offer a full suite of clinical programs to fit your needs and will work with you to customize a benefit package that makes sense for you and your employees. These programs help encourage appropriate medication use, promote safety, reduce waste, and ultimately, help your employees make better health care decisions. Below is a brief description of a few of our programs.

High Narcotic Utilization

Although most members use prescription narcotics appropriately, abuse of prescription analgesics containing opiates has received increased attention.

This program reviews pharmacy claims information quarterly to identify members who may be using narcotics inappropriately – seeking prescriptions from several providers. Identified members are tracked on an ongoing basis and pharmacy limitations may be implemented.

Notification

The Notification program promotes safety and reduces costs for everyone. Requires physicians to provide additional information to verify benefit coverage.

Progression Rx (Step Therapy)

Most therapeutic classes of drugs have multiple medication options – and many of those are interchangeable. Although their clinical effectiveness is similar, the prices may vary widely. This program helps steer members to less expensive, but equally effective medications when they are available – and then step up, if necessary, to more costly options.

Supply Limits

Our Supply Limits program addresses safety, reduces waste and removes excess costs by establishing a maximum quantity of medication that can be dispensed.