County of Los Angeles Pharmacy Program

This overview of the County of Los Angeles Pharmacy Program discusses how Express Scripts controls cost, captures prescription needs, and ensures safety for patients while preventing fraud and abuse.

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About County of Los Angeles Pharmacy Program

PowerPoint presentation about 'County of Los Angeles Pharmacy Program'. This presentation describes the topic on This overview of the County of Los Angeles Pharmacy Program discusses how Express Scripts controls cost, captures prescription needs, and ensures safety for patients while preventing fraud and abuse.. The key topics included in this slideshow are Greater Care, Zero Waste, Express Scripts, pharmacy program, cost control, prescription needs, formulary, clinical programs, patient safety, fraud prevention,. Download this presentation absolutely free.

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1. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 1 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. County of Los Angeles Pharmacy Program Overview October 2011

2. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 2 What Well Discuss Why Express Scripts for Workers Compensation (WC) Overview of the Pharmacy program How the program controls cost Capturing First Fill and On Going prescription needs Formulary and Clinical programs Safety for patient Prevents fraud and abuse Resources for you and your claims handlers Program support

3. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 3 Workers Compensation Industry Leader Nationwide Workers Compensation pharmacy network Workers Compensation injury-specific formularies Aggressive paper bill solution Industry-leading technology Clinical Advisory Committee to ensure clinical program effectiveness Leverage clinical experience to offer improved outcomes and savings Serve the injured worker while driving to the lowest net cost Serve the injured worker while driving to the lowest net cost Express Scripts ensures safety for your injured workers, while aggressively reducing waste

4. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 4 Drive Out the Waste Ease of administration and process efficiencies further drive savings Ease of administration and process efficiencies further drive savings

5. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 5 Comprehensive Pharmacy Program Proven pharmacy solutions delivering safety , savings, and satisfaction Our solution is a complete package for Workers Compensation Our solution is a complete package for Workers Compensation Core Services Core Services Trend Programs Trend Programs Clinical Programs Clinical Programs

7. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 7 Script can be filled before the claim is reported 14 Day Supply Eligibility 1- Work Comp Acute Drug List 2- Standard List for Ongoing Needs Formulary Management Assures that non-formulary medications are identified and sent for approval Prior Authorization Best practices in each key operation drive safety, savings, and satisfaction Best practices in each key operation drive safety, savings, and satisfaction Value of First Fill Form

9. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 9 Nationwide Pharmacy Network Express Scripts-owned network is contracted directly with pharmacies, specifically for workers compensation More than 57,000 pharmacies nationwide Includes major retail chains in Los Angeles County Wal-Mart Target Express Scripts will recruit additional pharmacies to meet your needs Contracting standards urban area within 1 mile suburban with 5 miles and rural within 15 miles Express Scripts goal: a network pharmacy within one mile of an injured worker Express Scripts goal: a network pharmacy within one mile of an injured worker Rite Aid Albertsons CVS Ralphs Pharmacy

10. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 10 Core Services Dedicated Workers Compensation resources and capabilities Formulary Management Account service team Patient care contact centers Home delivery pharmacy Reporting

11. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 11 Clinical Programs Clinical Programs Concurrent Drug Utilization Review Retrospective Drug Utilization Review Physician Outreach Program Step Therapy ScriptAlert Pharmacists Drug Review (PDRx) Increasing safety and clinical effectiveness

12. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 12 Clinical Programs Drug Utilization Review Concurrent DUR Retrospective DUR Goal of review Deter fraud and abuse and increase patient safety Review occurs At point-of-service After script is filled Corrective action Dispensing pharmacist alerted Physicians alerted on findings Designed to ensure injured worker safety Designed to ensure injured worker safety

13. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 13 Delivering Savings to Clients Physician Outreach Program Goal: Decrease use of brands and increase generics being dispensed Goal: Decrease use of brands and increase generics being dispensed Delivering Savings to Clients

14. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 14 Trend Programs Step Therapy (effective 1/1/12) Encourages use of generics before more costly brand-name alternatives Encourages use of generics before more costly brand-name alternatives

15. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 15 Clinical Programs ScriptAlert Reporting We identify potentially high-risk claims Send Monthly report Client can take appropriate course of action Aggressive case management Independent medical examinations Physician or peer-to-peer conversations Enabling Patient Safety

16. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 16 Clinical Programs Pharmacist Drug Review (PDRx) Submit request with all pertinent medical records Request Request 1 Review Review 2 Licensed pharmacist reviews injured workers complete medical file Report Report 3 Clinical assessment conducted to: Identify specific drug therapy problems Offer recommendations Propose desired clinical outcomes

18. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 18 Contact Center Pharmacy assistance, new claims, eligibility updates, medication approvals, etc. Call 24/7 at 1-800-676-5774 or email RetailCard@express-scripts.com Client Support Center (CSC) Escalated pharmacy and eligibility requests Call Monday Friday 5:30 am-5:30 pm (MST) at 1-877-292-1226 or e-mail ExpressComp@express-scripts.com Mail Conversion Center (MCC) Assistance with converting injured workers scripts to Home Delivery Call Monday Friday 7:30 am-5:00 pm (CST) at 1-866-533-6227 or e-mail WorkCompMCC@express-scripts.com Account Management Support Assist with program changes and escalations beyond above teams dmdesrosiers@express-scripts.com or 800-332-5455 ext. 232203 mmeyer@express-scripts.com or 800-332-5455 ext. 433175 Express Scripts Resources

19. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 19 Drug Information www.drugdigest.org Evidence-based website Drug information Drug interactions Generic availability Approved indications (reasons for use)

21. Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL 2011 Express Scripts, Inc. All Rights Reserved. 21 Alignment with County of Los Angeles Our program is designed to meet your business objectives Our program is designed to meet your business objectives 1 2 3 Safety Safety Savings Savings Satisfaction Satisfaction