|
Managed Care for pharmacy management is a shorthand description for the application of cost containment techniques that contribute to sustaining and improving outcome performance. Almost any benefit program that is substituted for a general fee-for-service program may bear the managed care description when there are therapeutically appropriate controls applied to dispensing and where monitoring measures are utilized. DpRx has invested in a continuing "work in progress" for its TeleCLAIM software system. The system provides a myriad of empirical techniques of optimizing drug costs and improving outcome performance. These techniques have been implemented one after another over 12 years, since 1988, in collaboration with a number of clients with innovative ideas and programs to accomplish a variety of benefit plan objectives. See Executive Summary of TeleClaim System. A number of different approaches have been implemented during these years and each has the following common characteristics:
The first characteristic of lowest cost to the benefit sponsor are the following control functions that are commonly employed to most plans for the greatest reductions in ultimate cost:
These cost savings are discussed in more detail in an enclosed article entitled "Understanding Today's Pharmacy Cost Containment Startegies" that may be linked to from here. The DpRx TeleCLAIM system is comprised of the following functions: Real-time and online data communications between providers and prescribers with the central TeleCLAIM processor and master data bank. Adjudication of submitted prescriptions for data correctness, eligibility confirmation, pharmaceutical appropriateness, application of financial incentives and limitations, data storage of completed and dispensed claims. The story of successful drug benefit programs includes an outstanding outcome performance record. The total impact in Hospital Admissions is not known but everyone admits to the tremendous influence it has on reducing overall medical budget costs. An important part of the contribution to these factors is the attention and features of the TeleCLAIM system that assist and improve patient compliance. Several TeleCLAIM collateral products have as their primary goal the improvement of patient compliance with the therapy regimen prescribed by the physician. Review of the Internet & Voice response section of this website describes the features that can contribute to a successful compliance statistics of your drug benefit program. |
|||||||||||||||||||||||||||||||||
 |
