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.