Medical Management

Pharmacy Risk Management Program

Pharmacy Program Overview

BIDPO contracts with Healthcare Data Services (HDS) for data management including pharmacy data services.  BIDPO’s pharmacy risk management program utilizes HDS Script Manager™, a comprehensive therapeutic interchange system and HDS Analyst,™ a customizable data reporting system.  Both HDS programs provide BIDPO and its member prescribers with successfully proven strategies to gain more adequate control of pharmaceutical expenditures while simultaneously insuring the highest possible level of quality care and service for patients. Additionally, the HDS programs provide data solutions to support pharmacy Pay-for-Performance (P4P) initiatives and efforts to increase generic utilization rates for outpatient prescribing.  BIDPO also contracts with MedVentive for clinical pharmacist support.


MedVentive P&T Committee

BIDPO has representation on the MedVentive Pharmacy & Therapeutics (P&T) Committee.  This committee is responsible for the of the MedVentive Universal Drug Formulary which is published annually.  The P&T committee is comprised of primary care physicians from BIDMC and BIDPO, as well as physicians from other physician groups who utilize MedVentive’s pharmacy program, plus your BIDPO clinical pharmacists. In addition, supporting this committee are 12 specialty sub-committees comprised of key BIDPO/BIDMC specialists from various therapeutic areas who provide consultation on formulary decisions and other educational activities.

The Committee’s mission: “To provide health care providers with unbiased, academically-driven drug evaluation, education and a universal drug formulary, all designed to optimize the balance between evidence-based medicine and fiscal responsibility in a managed care risk environment.”

BIDPO/ MedVentive Universal Drug Formulary

BIDPO and its prescribers may use the MedVentive Universal Drug Formulary. Originally developed in 1998, this “Universal” formulary document provides clinicians with a single frame of reference for drug therapy decision-making for all patients, regardless of insurer, or lack thereof. This unique formulary eliminates the need for providers to keep track of the numerous, often conflicting, formularies from various insurers and pharmacy benefit managers (PBMs). Medications included within this universal formulary represent the safest, most effective, and most cost-efficient agents available across most major drug categories. The drug selection criteria of the formulary is in no way influenced by any discount/rebate contracts with drug manufacturers which often complicate formulary selection procedures at the insurer and PBM level, and inevitably can drive costs for patients. Rather, drug acquisition cost comparisons are driven by the more universal average wholesale pricing (AWP) standard.

Academic-Detailing Support

At the heart of the BIDPO Pharmacy Management Program is an "academic-detailing" team comprised of three clinical pharmacists. This group of highly experienced, clinically adept and managed care savvy pharmacists is responsible for one-on-one detailing and group education with providers. Deployed locally to assigned practice sites, they serve as the primary drug information resource for clinicians and assist in drug utilization review activities, education regarding new and existing drugs, as well as dissemination and interpretation of individual and group prescribing data. The pharmacists work closely with designated physician leadership at BIDPO sites to target opportunities of greatest clinical and financial relevance, and develop strategies for quality improvement. The pharmacy team is also significantly involved in the management of therapeutic interchange activities to help improve BIDPO's performance with P4P contracts (specifically generic utilization). The BIDPO clinical pharmacists also can help to better manage pharmacy sales rep detailing and sampling, and work closely with other clinical and administrative staff to achieve targeted outcomes.

 

Pharmacy Data and Information Systems

The pharmacy management program, like BIDPO/BIDMC is equipped with one of the most comprehensive and sophisticated pharmacy utilization reporting systems in the industry created by Healthcare Data Services (HDS). Physician leadership, executives, administrators, clinical pharmacists, case managers, and key front-line providers are all able to access a variety of information on drug utilization patterns from a portfolio of comprehensive pharmacy reports. Most of these reports are available in a highly secure format and each provides unique drilldown capabilities.

Script Manager™ by Healthcare Data Services (HDS)


In January 2009, BIDPO began using a new, comprehensive therapeutic interchange application, Script Manager™, developed exclusively for BIDPO by Healthcare Data Services (HDS).

Through this custom HDS application, all pharmacy claims received from third party insurers are run through a comprehensive screening process. This pharmacy claim screening process identifies the most recent prescriptions filled by individual patients. Based upon a set of predefined set of clinical criteria, the HDS Script Manager™ then flags  prescription claims that represent potential opportunities for therapeutic interventions. Script Manager™ is currently being utilized to drive Rx P4P generic utilization initiatives by identifying brand-name prescription claims that may be clinically appropriate for a change to a generic drug product within the same therapeutic drug class. Brand-to-generic Script Manager™  interchanges typically reduce pharmacy copayments for patients (i.e. 1st tier generic copay versus 2nd or 3rd tier brand copay) and helps BIDPO achieve its Pharmacy Pay for Performance (P4P) measures with BlueCross BlueShield (BCBS-MA), Harvard Pilgrim Healthcare (HPHC) and Tufts Health Plan.

Each therapeutic interchange consists of three documents:

  • Interchange Detail Report - This report includes the details of the interchange including the patient’s script history.
  • Prescription Blank - A pre-populated script blank.
  • Patient Letter - This letter informs the patient of the change in medication.

Every effort has been made to ensure that BIDPO achieves the highest quality of pharmaceutical care for the majority of patients so that no change in safety or efficacy will occur as a result of this interchange process.

SUMMARY

With an aging population, more aggressive drug marketing, and more advanced drug technology development, pharmacy costs will undoubtedly continue to grow at a steady pace. This will result in increased pressures for health care organizations charged with balancing the management of these costs with insured quality of care and service for the patients we care for. In recognition of these growing challenges, BIDPO has built a pharmacy management infrastructure which we believe provides unique and powerful means by which to achieve these goals in a complex healthcare marketplace. BIDPO’s collaboration with Healthcare Data Services (HDS) and their analytical data support systems has provided our organization with proven benefits to date and an excellent opportunity for continued success in its pharmacy management efforts.