Humana Teams Up with CoverMyMeds to Improve Prior Authorization Process for Members

LOUISVILLE, Ky.–()–Humana Inc. (NYSE: HUM) and CoverMyMeds, a leading health care innovation company, have recently teamed up to implement an electronic prior authorization model that allows providers to streamline prescription authorization requests, giving patients expedited access to the medications they need.

“Depending on the prescription, some medications require prior authorization before coverage which, as of now, is a time-consuming process for all parties”

Under the new agreement, physicians can submit drug prior authorizations directly to Humana via an online portal. The requests begin processing immediately and providers receive a notification of the status of the member’s prior authorization, often before the member even leaves the doctor’s office. Continue reading

Private Exchanges Create PBM Uncertainty

The featured article in  today’s AIS’s Health Business Daily delves into the  question of what role PBMS will play as employers move to private exchanges.

While the growth of private exchanges — and public exchanges, for that matter — poses some risks to PBMs in terms of disrupting the traditional business relationships PBMs have with employers, there are some possible positives… See AISHealth.com for the full story.

Healthcare Reform Heats up Drugstore Battle

The healthcare reform law will expand access to medical services for millions of people. That’s going to place added pressure on primary healthcare providers and challenge the system to meet the new demand.

So it may not be surprising that the nation’s three major drugstore chains are gearing up to play a bigger role. They’re placing retail health clinics in their stores, pushing their pharmacists to be more proactive with their prescription customers, and even entering partnerships with big medical groups.

See the full story at LATimes.com

 

Report Gives Health Plans Reasons to Fight Copay Coupons

Visit nearly any official website for a brand-name drug available in the United States and, mixed in with links to prescribing and safety information, you’ll find links to drug “coupons,” including copayment-assistance programs and monthly savings cards. Most offers are variations on “Why pay more? With the [drug] savings card, you can get [drug] for only $18 per prescription if eligible” or “Get a free 30-capsule trial of [drug] with your doctor’s prescription and ask your doctor if [drug] is right for you.” Why do manufacturers offer drug coupons? Are they good for patients in the long run? Are they even legal?

The widespread availability of coupons for brand-name pharmaceuticals that can be expected to be used long term and for which lower-cost alternatives are available has important implications for patients.

See the full story at New England Journal of Medicine

Express Scripts, Walgreens To Offer 90-Day Retail Solution

In an unexpected display of camaraderie, Express Scripts Holding Co. and Walgreen Co. have come up with a new offering presumably aimed at competing with CVS Caremark Corp.’s highly successful Maintenance Choice program. Industry observers say the launch of Smart90 Walgreens is a plus for both parties and reflects increased interest in custom retail networks.

In a joint press release issued on Aug. 1, the companies said Smart90 Walgreens is designed for Express Scripts clients that are “interested in 90-day prescription drug programs that drive lower costs and improve health outcomes for people with chronic diseases who require long-term treatment.” Not only will clients achieve savings from more aggressively discounted pricing on 90-day prescriptions, but the program has the potential to increase medication adherence by cutting down on the number of opportunities a member has to forget to fill a prescription, maintain the companies.

Read the full story at AISHealth.com

 

Privacy, Pharmacy Groups at Odds Over Refill Reminder Funding Rule

Should drugmakers and other third parties be able to fund refill reminder programs?  The World Privacy Forum — a privacy rights group — doesn’t think so and is is challenging an effort by the Specialty Pharmacy Association of America (SPAARx) to convince HHS to change a privacy rule that would limit funding for prescription refill reminder programs, Modern Healthcare reports.

The battle between privacy advocates and the pharmaceutical industry highlights the debate over the use of data in patients’ health records without patient consent (Conn, Modern Healthcare, 8/16).

Read more of this story at IHealthbeat.org and find out which major drug store chain has said that it would no longer offer refill reminder programs that are funded by the pharmaceutical industry.

 

Priority Health Pharmacy Initiatives Save $50 Million over 5 Years

GRAND RAPIDS, Mich.–(BUSINESS WIRE)–As rising pharmacy costs continue to plague the health system, Priority Health’s pharmacy management initiatives have protected its members while keeping costs far below the national average for five years. The 4% savings equates to nearly $10 million per year and more than $50 million over five years.

“Pharmacy is one of the critical components that make up the cost of health care”

“Pharmacy is one of the critical components that make up the cost of health care,” said Kimberly K. Horn, president and CEO for Priority Health. “It’s an area we have committed significant resources to and created significant savings from, and in-turn, passed those savings along to our customers through lower premium increases.”

The facts around pharmacy are staggering, especially if you consider that each day Priority Health:

  • Processes 15,000 prescriptions with a total price tag of $1 million
  • Approves new specialty drugs that often cost up to $35,000 annually for a single patient (or member)
  • Pays for brand name drugs that account for 75 percent of costs and annual price increases of 8-10 percent
  • Reviews specialty drugs that can account for 20 percent of an employer’s health care costs

“Despite significant cost increases in pharmacy, Priority Health has developed programs that not only reduce costs and improve the quality of care but also deliver an exceptional customer experience,” adds Horn. “We distinguish ourselves by working closely with physicians, our staff pharmacists and our customers to create programs that deliver better health care outcomes and lower out-of-pocket costs.”

Employers and members see the greatest benefit of Priority Health’s innovative approach to health care when the medical plan and pharmacy plan are linked. By analyzing claims and pharmacy data, Priority Health has been able to ensure that customers get the safe and appropriate care. The company reviews pharmacy claims in “real-time” to determine whether a member is experiencing significant health issues and needs additional assistance. Once identified, these members are enrolled in its award-winning case and disease management programs.

Priority Health’s generic drug utilization continues to deliver significant savings. Nearly 80 percent of the prescriptions filled by its customers are generics. The company also offers:

  • A network of 60,000 pharmacies nationwide to provide services
  • Money saving benefit designs: 2-tier, 3-tier and 3-tier with specialty drug management
  • Low or no dispensing fees
  • Pharmacy case management services promote safety, effectiveness and cost-savings
  • A comprehensive support program that includes case management services for employees with chronic medical conditions
  • Expert resources, including a panel of physicians and pharmacists, who collaborate to build an approved list of safe, effective, FDA-approved medications and therapy management programs
  • A searchable, online approved drug list to help members determine if their prescriptions are covered and identify costs
  • Cost-sharing options that promote sensible prescription choices

More information about Priority Health’s pharmacy programs and success with managing costs is available on priorityhealth.com.

About Priority Health:

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups, individuals and Medicare and Medicaid. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be ranked among America’s best health plans by the National Committee for Quality Assurance.

 

BCBSNC Establishes Network Of Accredited Specialty Pharmacies

CHAPEL HILLBlue Cross and Blue Shield of North Carolina (BCBSNC) is establishing a new network of specialty pharmacies to help customers better manage their complex, chronic health conditions and to address the rising costs of these prescription medications. These network changes will not affect customers’ prescription drug benefits in any way and customers may continue to receive non-specialty medications at any pharmacy in BCBSNC’s pharmacy network.

  • Specialty pharmacy network provides customers with nursing or pharmacist services 24 hours a day, disease specific evaluations and other benefits.
  • Specialty medication costs are expected to rise 13 to 15 percent annually over the next few years. BCBSNC’s new specialty pharmacy network is expected to moderate these increases.
  • Change does not affect Medicare Part D customers.

The BCBSNC specialty pharmacy network consists of pharmacy providers that have met rigorous criteria, including quality accreditation through URAC, a national and independent organization that promotes health care quality and efficiency. Pharmacies who meet the network criteria will offer the following comprehensive services:

  • Available nursing or pharmacist services 24 hours a day, 7 days a week, 365 days a year.
  • Disease specific initial and ongoing evaluations, monitoring of medication adherence and counseling.
  • Convenient mail order service, with delivery to a customer’s location of choice.

Specialty medications are costly drugs that typically treat chronic conditions such as multiple sclerosis and rheumatoid arthritis. Specialty medications can be received through a customer’s medical or pharmacy benefits. These types of drugs often require special preparation and handling, such as mixing and refrigeration. Specialty drugs are typically those in tier 4 of BCBSNC’s prescription drug formulary. All pharmacies in the new network are specially equipped to handle dispensing specialty medications.

“The specialty pharmacies in our new network have met strict criteria for participation, including accreditation through an independent accrediting organization,” said Estay Greene, director of BCBSNC pharmacy programs. “These pharmacies have demonstrated their ability to offer comprehensive medication support to our customers.”

Specialty medication costs are on the rise, expected to increase 13 to 15 percent annually over the next few years. BCBSNC expects the new specialty pharmacy network to help moderate these increases. Specialty pharmacies in BCBSNC’s new network have staff available to help answer questions about medications, offer financial counseling and provide other support services.

Customers will still be able to receive non-specialty medications at any pharmacy in BCBSNC’s pharmacy network. The establishment of this specialty pharmacy network does not affect prescription drug benefits in any way.

Letters will be mailed to all individual customers who are affected by the change and include detailed information and instructions. Beginning July 1, customers can begin transferring any remaining refills on specialty prescriptions from their current pharmacy to a pharmacy in the new specialty pharmacy network.  By Aug. 15, 2011, all affected customers must use pharmacies within the specialty pharmacy network for their specialty medications in order to receive in-network benefits. The change does not impact BCBSNC’s Medicare Part D customers.

For additional information, customers are asked to contact BCBSNC at the toll-free customer service number listed on their ID card or visitwww.bcbsnc.com.

Pharmacies participating in BCBSNC’s specialty pharmacy network as of July 1, 2011:

  • Ascend Specialty Rx
  • Biologics
  • BioPlus Specialty Pharmacy
  • BioScrip
  • CommCare Pharmacy
  • CoramRx
  • CuraScript
  • CVS Caremark
  • DrugCo Health
  • Kerr Health
  • Long’s Drugs
  • MedPro Rx
  • US Bioservices

About BCBSNC
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 77 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at http://www.bcbsnc.com .

 

Walgreens Completes drugstore.com Acquisition

DEERFIELD, Ill., June 03, 2011 – Walgreen Co. (NYSE: WAG)(NASDAQ: WAG) today announced that it has completed its acquisition of drugstore.com. The transaction includes all websites directly owned and operated by drugstore.com, as well as its corporate office and customer service and distribution center operations.

The transaction, which represents a total enterprise value of approximately $409 million, follows Walgreens acquisition last year of New York-based drugstore chain Duane Reade. The addition of drugstore.com’s strong online business across its health, personal care, beauty and vision categories better positions Walgreens as the most convenient multi-channel retailer of health and daily living needs in America.

“We welcome drugstore.com’s leaders and employees to the Walgreens family,” said Walgreens President and CEO Greg Wasson. “drugstore.com complements Walgreens center of gravity — our 7,700 drugstores ? by extending many of our own multi-channel initiatives that have been driving our growth. This acquisition also provides us a unique opportunity to access more than 3 million savvy, online loyal customers, and move even closer to our existing customers through relationships with new vendors and partners, adding approximately 60,000 products to our already strong online offering.”

Walgreens President of E-commerce Sona Chawla will lead the combined e-commerce business. Dawn Lepore, former drugstore.com CEO and chairman, will continue through a transition period as a strategic advisor to Chawla.

“Today we are better positioned than ever before to offer our customers what they want, when they want it and where they want it? in our stores, online or through their mobile devices,” said Chawla. “We want to provide our customers an exceptional experience, and together with drugstore.com, we will give them more ways to connect and buy, easy access to a wide selection of products and services and increased delivery options. We are committed to joining drugstore.com’s talented team with our strong and growing e-commerce organization.”

drugstore.com will maintain separate branding of its websites. Over the long term, Walgreens will fully integrate the two businesses and intends to enhance its multi-channel product assortment and the overall customer experience by leveraging drugstore.com’s current websites.

About Walgreens

Walgreens (www.walgreens.com) is the nation’s largest drugstore chain with fiscal 2010 sales of $67 billion. The company operates 7,689 drugstores in all 50 states, the District of Columbia and Puerto Rico. Each day, Walgreens provides nearly 6 million customers the most convenient, multi-channel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice in communities across America. Walgreens scope of pharmacy services includes retail, specialty, infusion, medical facility and mail service, along with respiratory services. These services improve health outcomes and lower costs for payers including employers, managed care organizations, health systems, pharmacy benefit managers and the public sector. Take Care Health Systems is a Walgreens subsidiary that is the largest and most comprehensive manager of worksite health centers and in-store convenient care clinics, with more than 700 locations throughout the country.

About drugstore.com

drugstore.com, inc. is a leading online retailer of health, beauty, clinical skincare, and vision products. The drugstore.com portfolio of brands includes: drugstore.com™, Beauty.com™, SkinStore.com™ and VisionDirect.com™. All provide a convenient, private and informative shopping experience, while offering a wide assortment of approximately 60,000 non-prescription products at competitive prices.

The drugstore.com pharmacy service, in association with BioScrip Pharmacy Services, Inc., is certified by the National Association of Boards of Pharmacy (NABP) as a Verified Internet Pharmacy Practice Site (VIPPS) and complies with federal and state laws and regulations in the United States.

 

Humana’s MyHumana Mobile App Now Makes It Easier For People To Manage Their Prescription Costs

LOUISVILLE, Ky.–(BUSINESS WIRE)–Millions of Humana members will now find it easier to compare the cost of prescription drugs and explore available alternatives. Humana has updated its industry-leading MyHumana Mobile app and mobile website to include prescription drug pricing. The Drug Pricing feature allows members to quickly determine the cost of their prescriptions, identify lower-cost alternatives and compare the costs of the prescription from multiple pharmacies and Humana’s RightSourceSM home delivery pharmacy and RightSource SpecialtySM pharmacy. The new drug-pricing feature bolsters Humana’s “Appy Award”-winning technology which improves members’ health and well-being and arms them with powerful tools at the point of service.

“This is just the first of what will be numerous deployments of functionality and transactions regarding prescriptions in the mobile space”

“Traditionally we have sent members messages after they purchased a prescription when a lower-cost alternative was available. Now, this price information can be looked up by members while at the doctor so that a lower-cost alternative can be considered before the prescription is written or to help the member find the best price for the prescription,” said William Fleming, vice president, Humana Pharmacy SolutionsSM (HPS). HPS, a division of Humana Inc., manages traditional pharmacy benefits with member-focused strategies to yield savings in pharmacy and total health expense. “This is just the first of what will be numerous deployments of functionality and transactions regarding prescriptions in the mobile space,” Fleming said.

The free MyHumana app and Humana’s mobile website, m.humana.com, also feature a mobile member information tool that shows users personalized details about their health plan on demand, including their Member ID card information. Humana’s health and well-being app allows members to check their medical and pharmacy claim status and details. Members are also able to search for health care providers to obtain provider credentials, affiliations, phone numbers, driving directions and maps. The mobile spending account viewer displays recent activity and current balance details for people using spending accounts, such as Health Savings Accounts.

MyHumana Mobile launched in March 2010 and continues to regularly add more personalized resources. MyHumana Mobile has a five-star rating in Apple’s App Store and can be downloaded for Apple’s iPhone, iPod Touch and iPad. MyHumana Mobile is also available from the Android Market for phones running Google’s Android operating system. Members can also access prescription drug pricing and other relevant information by directing their mobile browser to m.humana.com.

About Humana Pharmacy Solutions

Humana Pharmacy Solutions (HPS) is the free-standing business unit within Humana Inc. that manages traditional pharmacy benefits with member-focused strategies to yield savings in pharmacy and total health expense. HPS manages prescription coverage for both individuals and employer groups for all Humana segments, as well as on a stand-alone basis for employers and 3rd party administrators. HPS operates prescription home delivery services for traditional mail order and specialty drugs, as well as research services. Members are provided access to the medicine they need while offered guidance on clinically proven, therapeutically equivalent treatments.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.