Pharmacy Benefit Management Services

®
Pharmacy Benefit Management Services
Excellence in Pharmacy Services . . . It’s Yours with MAXOR
Dedicated & Accessible
Account Management
Each of MaxorPlus’ clients have a dedicated Account
Management Team comprised of an Account
Manager, Clinical Manager, and Senior Manager.
This team provides prescription drug benefit plan design, analysis and
cost projection recommendations, and quarterly prescription drug
benefit program reviews. Our high-touch model allows personalized
service to all clients while saving hard dollars in claims cost and
providing quality customer service.
Our proactive Account Management Team works with clients on a
daily basis to ensure program effectiveness and resolve any questions.
A MaxorPlus representative meets with clients annually, or more often
as needed. Having a dedicated Account Manager allows clients to
contact one person should any issues arise.
In addition, each individual will have special responsibilities as part
of the Account Management Team for our clients. The Account
Management Team is comprised of a group of individuals with a wide
range of expertise in operations, pharmacy network management,
clinical pharmacy, systems administration, eligibility management,
customer service, finance, account management and marketing.
Our dedicated Pharmacy Network Department works with network
pharmacies prior to plan implementation by developing and distributing
pharmacy network communications; responding to pharmacy network
inquiries; and all other components related to MaxorPlus’ retail
pharmacy network.
MaxorPlus’ Account Management Team has been designed to provide
immediate access to key staff while maintaining centralized management
and accountability.
The following individuals will play a critical role during implementation
and ongoing activities:
• Account Manager
• Clinical Pharmacy Manager
• Director of Operations
• Division Controller
• Eligibility Coordinator
• Pharmacy Network Coordinator
• Senior Systems Administrator/Quality Control Coordinator
Customized Member Communication Materials
MaxorPlus provides all member materials, including:
• Customized ID card production
• Member Packets
– Welcome letter
– Member brochure
–Formulary
– Preferred Drug Alternative Listing
– Specialty pharmacy restriction list (if applicable)
– Mail order packet
Experienced & Friendly
Customer Service
MaxorPlus offers toll free telephone access to customer service
representatives for use by benefits personnel, plan members,
participating pharmacies and physicians. Our experienced
representatives provide response to inquiries concerning:
•
Plan eligibility
•
Plan guidelines
•
Deductible & maximum benefit status
•
Required co-payment levels
•
Location of participating pharmacies
•
Status of identification cards
•
Instructions for completing a paper claim
•
Network pharmacy questions
•
MaxorPlus website assistance
•
Pharmacy claim assistance
•
Prior authorizations
Maxor Mail Order-specific questions:
•
Medication refills request
•
Prescription order status
•
Medication questions
•
Information for new mail order customers
•
Medication transfer instructions
All Customer Service Representatives participate in extensive initial
and ongoing training. A pharmacist is available 24 hours a day,
7 days a week for urgent matters.
The MaxorPlus Customer Service Department is
comprised of a staff of well-trained Customer Service
Representatives (CSRs), Team Leaders, Customer Service
Management Staff, and the Director of Operations,
who are collectively responsible for providing the
highest level of customer service. The majority of
CSRs are experienced retail pharmacy technicians or
experienced Customer Service Representatives.
Online Member Services
Registered online members have access to many
user-friendly tools, including:
• Personal prescription profile
• Convenient online mail order refills
• Copay calculator
• Preferred and generic alternatives
• Drug information
• Network pharmacy locator
Flexible & Accurate
Reporting
MaxorPlus’ Executive Summary Report Packages are distributed to clients
monthly and are available both electronically and in print. Each Executive
Summary Report includes:
Cost Analysis
Pharmacy Network Analysis
• Number of members
• Pharmacy payment summary
• Number of claims
Drug Utilization Analysis
• Gross cost
• Brand-generic utilization
• Member copays and
deductibles
• Top 20 drugs sorted by # Rxs
• Top 20 drugs sorted by total cost
• Plan cost (net cost)
• Plan cost PMPM
Recipient Analysis
• Copay PMPM
• Age audit
• Utilization PMPM
• Plan cost per Rx
Physician Analysis
• Copay per Rx
• T
op 20 physicians sorted
by # Rxs
• Copay % of gross cost
• T
op 20 physicians sorted
by total cost
• % generic usage
DEMONSTRATION REPORT
TOP PHARMACY ANALYSIS
TRANSACTION DATE FROM: 06/01/2010 THROUGH: 06/30/2010
Pharmacy Category
# Rxs
U&C Amt ($)
Amt Paid ($)
Page 4 of 11
Avg Rx ($)
2,166
781,289.90
74,303.17
440,584.96
Retail
4,994
425,504.24
76,630.84
228,348.90
45.72
39
211,926.90
3,786.31
84,579.74
2,168.71
TOTAL FOR ALL PHARMACY CATEGORIES
7,199
1,418,721.04
154,720.32
753,513.60
104.67
GRAND TOTAL
7,199
1,418,721.04
154,720.32
753,513.60
104.67
Specialty
DEMONSTRATION REPORT
BRAND-GENERIC UTILIZATION
TRANSACTION DATE FROM: 06/01/2010 THROUGH: 06/30/2010
Page 3 of 11
Copay ($)
Mail Order
% Rxs
% Total Cost
30.96%
74.60%
203.41
SINGLE SOURCE BRANDS
Avg Member
Paid ($)/Rx
43.92
Avg Amt
Paid ($)/Rx
Avg Total
Cost ($)/Rx
260.04
303.96
# Rxs
Days
2,229
118,279
579,620.65
Amt Paid ($)
Copay ($)
97,897.01
Total Cost ($)
677,517.66
MULTI-SOURCE BRANDS WITH NO GENERICS AVAILABLE
2.04%
1.93%
36.18
82.77
118.96
147
6,829
12,167.80
5,318.80
17,486.60
MULTI-SOURCE BRANDS WITH GENERICS AVAILABLE
1.88%
3.23%
43.56
173.45
217.00
135
7,359
23,415.11
5,880.01
29,295.12
79.75%
43.45
245.00
TOTAL FOR ALL BRANDS
TOTAL FOR ALL GENERICS
GRAND TOTAL
288.45
2,511
132,467
615,203.56
109,095.82
724,299.38
65.12%
20.25%
9.73
29.50
39.24
4,688
174,293
138,310.04
45,624.50
183,934.54
100.00%
34.88%
100.00%
21.49
104.67
126.16
7,199
306,760
753,513.60
154,720.32
908,233.92
12-Month % Rxs Generic Usage
June's Top5 by # Rxs
June's Top5 by Amt Paid
# Rxs
Amt Paid ($)
Chain/Pharmacy
MAXOR MAIL ORDER
2,166
440,584.96
MAXOR MAIL ORDER
WALGREEN CO.
1,752
Pharmacy Categories
# Rxs
Amt Paid ($)
2,166
440,584.96
72,829.20
MAXOR SPECIALTY PHARMACY
CVS
763
40,734.60
WALGREEN CO.
WAL-MART CORPORATION
494
16,326.94
CVS
763
40,734.60
KROGER-HEADQUARTERS
449
18,688.96
KROGER-HEADQUARTERS
449
18,688.96
39
1,752
84,579.74
72,829.20
1 Report Package (1_report_package_charts)
1 Report Package (1_report_package_charts)
7/19/2010 3:58:17 PM
7/19/2010 3:58:41 PM
MaxorPlus offers its clients access to data reports through MaxSource and
MaxView, both based on industry leading platforms.
Timely and accurate reporting is a key component
for clients to evaluate and participate in the management
of their plan.
Retiree Drug Subsidy Assistance
MaxorPlus has a team which assists with the
Retiree Drug Subsidy program for our clients.
Our team facilitates the RDS application
process, including:
• C
oordinating the actuarial attestation
and supporting all application components
• Uploading monthly retiree costs
• Helping coordinate eligibility files with
the client and CMS
• P
roviding final reports for
reconciliation purposes
Integrated Pharmacy Reporting
Maxor’s reporting system is integrated with all claims data,
including mail order, retail, and specialty pharmacy.
Adaptable & Attentive
Clinical Pharmacy Management
The MaxorPlus clinical department can fully administer the clinical
services, or can assist in managing our clients’ clinical services, from prior
authorizations to step therapy, quantity limits, and more. These programs
are customized to meet each individual client’s needs. Most of the clinical
programs are targeted to both the patient and the providers.
Our consultative approach by clinical pharmacists for pharmacy benefit plan
design and coverage recommendations has proven to be a valuable tool for
our clients when designing their prescription drug programs.
Clinical Pharmacy Initiatives
• Formulary development and management
• Drug utilization review
(concurrent, retrospective, prospective)
• Educational programs
• MaxResults clinical programs
– Implementation of quantity limits – Auditing
– Targeted/focused
– Clinical prior authorization
interventions
administration
– Plan analysis
– High claims cost monitoring
– Generic incentive
– Narcotics monitoring
programs
– Step therapy programs
–Specialty pharmacy
– Adherence monitoring
programs
– Mail order interventions
All of MaxorPlus’ clinical programs are monitored by our clinical staff,
in addition to our extensive reporting tool, to ensure cost containment
to our clients and safety for our members.
One of our goals as a Pharmacy Benefit Manager
is to effectively manage our clients’ prescription
drug costs while continuously improving the quality
of pharmaceutical care for members, through the
implementation of clinical pharmacy initiatives.
The MaxorPlus Preferred Drug Formulary is developed by physicians from
various areas of expertise and pharmacists who strive to ensure the most
cost-effective and medically appropriate drugs available are included.
Formulary drug selections are based upon each drug’s clinical efficacy,
side effect profile, pharmacokinetics, dosing regimens, drug/food
interactions, contraindications, toxicity & safety, monitoring requirements,
uniqueness/similarities to other agents, utilization trends, outcome studies
and cost-effectiveness.
MaxorPlus prides itself in providing a balanced formulary that offers
our members cost effective options in all therapeutic classes. By doing
so, member satisfaction levels with their benefits remain high while our
clients are able to save money on their prescription drug program. We will
proactively work to keep members and their doctors informed of all of their
therapeutic alternatives.
Completely Integrated
Comprehensive Network
MaxorPlus provides a comprehensive solution
for mail order pharmacy, retail network
pharmacies, and specialty pharmacy.
Maxor Mail Order Pharmacy
• Prompt, accurate dispensing, including barcode checking
• Convenient refills available online, using voice activated
telephone system, fax, or mail
• Delivery of 90 day medications to your home, office, or
alternate address
– Free standard shipping
–No additional customer charges for refrigerated medications
delivered via overnight or second day delivery
• Clinical drug interventions at the pharmacy dispensing level
• Delivery tracking available online
Retail Pharmacy Network
MaxorPlus’ comprehensive retail pharmacy network provides
pharmacy locations nationwide to plan members. Our clients and
members can access the MaxorPlus website to determine which
network pharmacies are available for them by searching for any
of the following: pharmacy name, city, state and/or zip code, or a
combination of any of these.
Specialty Pharmacy Services
Maxor Specialty Pharmacy applies strategies that manage the high
cost and complexity of specialty medications available through
medical and pharmacy benefits via our sophisticated data analysis,
ongoing communication and reporting tools.
Refill reminders and education are provided to patients by our
clinical staff, and convenient online refills are easily accessible to
patients. Maxor provides convenient medication delivery direct
to the patient, physician office or an alternate site of choice.
Medication shipments are coordinated, so they arrive when
requested by the patient and physician.
Maxor has extensive experience with chronic disease states.
Our goal in managing these conditions is to improve patient
adherence and outcomes through proactive management and
retrospective review. The list below is a sample of the chronic
disease states treated by Maxor Specialty Pharmacy.
• Asthma
• Infertility
• Crohn’s
• Multiple Sclerosis
• Cystic Fibrosis
• Oncology
• Diabetes
• Osteoporosis
• Gaucher Disease
• Pain Management
• Growth Hormone
• Psoriasis
• Hemophilia
• Rheumatoid Arthritis
• Hepatitis C
• RSV
• HIV/AIDS
• Transplant
• Immune Deficiency/IVIG
Since 1926, Maxor has met the challenges of an
evolving health care environment. From its beginnings
as a single pharmacy, today Maxor is a nationwide
provider of pharmacy services, helping clients shape
their healthcare futures.
Located in Amarillo, Texas, MaxorPlus has provided
Pharmacy Benefit Management (PBM) services since
1991, with fully integrated mail order pharmacy
services, specialty pharmacy services, clinical pharmacy
services, account management, customer service, retail
pharmacy network, and more, all in the same location.
®
Pharmacy Benefit Management Services
320S.PolkStreet
Amarillo,Texas79101
(806)324-5400•(800)658-6146
Fax:(806)324-5495
www.maxorplus.com