The MP CareSolutions team offers unique, experienced skillset to provide Advanced Pharmaceutical Management services. 

 

A growing concern.  

Pharmaceuticals have become the top medical expense and financial risk for Medicaid Managed Care and other safety net programs. Specialty drugs are approaching 35-40% of the drug spend at about $6,000/month for each member receiving this treatment. New specialty therapies for rare diseases are increasing this growing risk at a cost of over $100,000/year to as much as over $700,000/year per patient. Many of these individuals for whom these drugs are targeted have complicated clinical and social effects that require more attention, in addition to rationally managing the requested pharmaceuticals.

Social and environmental necessities? We can help.

  • Integrated and coordinated approaches to clinical care
  • Member and physician care coordination
  • Readiness for therapy
  • Experience in achieving desired outcomes
  • Analytics-based assessment capabilities

Proven success.

The Advanced Pharmaceutical Management Program targets high-cost specialty drugs before they are approved and dispensed. Prescribing these drugs requires an initial referral to and evaluation by case management before drug coverage approval. In this way, a validation of an individual’s clinical/cognitive stability, environmental and logistical appropriateness, and readiness for therapy can be achieved. Social determinants of health can be addressed, while coordinating the drug approval process with our Utilization Management department. This collaboration enhances both member and physician care coordination efforts.

This program further allows an assessment for the effectiveness of pharmaceuticals after they have been dispensed and administered to the member. Additionally, it allows for member monitoring, ensuring that the members receiving these high-cost therapies are appropriate enrollees in the health plan.

Institution of this program has achieved a return on investment estimated at a ratio of 3-5:1.