Pharmacy Pharmacy programs, formularies and electronic prescribing tools
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1 Pharmacy programs, formularies and electronic prescribing tools BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. This document has been classified as public Information.
2 Regional Pharmacy Directors Regional Regional Pharmacy Phone Office Directors Number Region 1 Johnson City Dr. Beverly Franklin-Thompson Region 2 Knoxville Dr. Mickie Ratliff Region 3 Chattanooga Dr. Natalie Tate Region 4 Nashville Dr. Andrea Knight Dr. Ashlie Singletary Region 5 Jackson Dr. Jeff Campbell Region 6 Memphis Dr. Jeff Campbell
3 Regional Pharmacy Director Overview Direct outreach to prescribers and clinical staff across the state Provide general and specific information related to prescription medications, pharmacy benefits and utilization Formulary changes Member specific data opportunities for less costly dosing options, gaps in lab monitoring, and drug interactions Employer group information - medication coverage changes, and co-pay details Clinical outreach programs based on medical information Continuing initiatives include diabetes, depression, and antibiotics Newer initiatives include medication compliance, and early intervention in non-compliant patients 3
4 Electronic Prescribing Pharmacy Changes to Medicare e-prescribing initiative Beginning 1/1/10, G8553 must be included on a minimum of 25 unique visits/yr G at least 1 Rx created in the encounter was generated and transmitted electronically using a qualified erx system Other criteria for Successful e-prescriber must still be met Possible changes in DEA Regulations on e-prescribing Beginning 6/1/10 (pending final approval), DEA regulations provide practitioners with the option of e-prescribing controlled substances Practice must comply with requirements and must have application certified by an auditor or approved certification body Identity proofing is critical to security. The DEA is allowing use of two of the following: -something you know (a knowledge factor) -something you have (a hard token stored separately) -something you are (biometric information) 4
5 Diabetes Gaps in Care Pharmacy Combines Medical and Pharmacy Data to create a Gaps in Care Report Providers targeted for intervention based on number of patients and gaps identified Between January 2008 December 2009, approximately 575 practitioners received patient specific data Between January 2008 December 2009, data was provided on approximately 25,000 members with diabetes Greatest benefit - Potential reduction of complications from diabetes thru appropriate monitoring and treatment Program expanding to other disease states in 2010 (COPD, Depression, etc.) 5
6 Specialty Pharmacy SP Rx drugs may fall under: Medical Benefits Pharmacy Benefits Pharmacy 24 significant new SP Rx drugs expected in 2010 See Web: specialtyprogram/specialtyrxdruglist.pdf Check Medical Policy website for medical appropriateness 6
7 Specialty Pharmacy (SP Rx) Four Preferred SP Rx Pharmacies: Caremark Specialty Accredo Health Group CuraScript, Inc Walgreens Specialty Pharmacy Many members must pay a double co-pay for their outpatient SP Rx products if they do not use one of the preferred specialty pharmacies. These preferred pharmacies offer supplemental educational and support services. 7
8 Specialty Pharmacy for Physicians For physicians serving BCBST s Commercial, TennCare, AccessTN, or CoverKid members, a provider-administered drug may be ordered from a preferred SP Rx pharmacy. The drug will be shipped to the physician s office and billed directly to BCBST. A preferred SP Rx pharmacy will assist the provider in obtaining the appropriate Prior Authorization 8
9 9
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