Improving member satisfaction and treatment outcomes with specialty drug benefit integration
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When it comes to specialty drugs, most health plans and pharmacy benefit managers focus on providing appropriate access to drugs and controlling costs. However, it is important to remember that the member is more than just their drug regimen.
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By integrating our members’ wellness across the health care continuum, Independence provides a more holistic and comprehensive philosophy of health care — one that leads to higher member satisfaction and improved treatment outcomes.
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Many carve‑out vendors claim they can offer the same clinical support as integrated benefits offer. This clinical support plays out in access to therapy, managing drug‑drug interactions, and continuity of care. However, the reality can sometimes be the opposite.
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As we discussed in last month’s Rx Corner, many people with chronic conditions are taking both specialty and standard medications, which spans across both medical and prescription drug benefits. The carve‑out vendors may not be able to fully support all components, leaving members to navigate a confusing and tedious clinical process, winding up with a suboptimal or potentially dangerous outcome.
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Here’s how Independence better‑supports our members through integrated specialty drug benefits:
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- End‑to‑end management for our members: Independence can provide end‑to‑end management for our members, with medical and prescription drug benefits and policies that work together. We have a network of highly trained health care professionals who provide preventive, diagnostic, and therapeutic access across the health care continuum. This includes lab work, timely screenings, imaging, genetic testing, surgical interventions, rehabilitation, and clinical drug management (at the point of prescribing, dispensing, through first use, and in recovery). This approach offers both better value and better care for our members.
- Initiating treatment more efficiently. Most specialty drugs require precertification or prior authorization approval to ensure the member meets coverage criteria in our policies before receiving the drug. Because we can access the member’s full treatment history, members can initiate therapy faster and more efficiently.
- Helping members navigate their entire health care journey. Our Clinical Management Programs make it easier for members to navigate their health care journey. Our Registered Nurse Health Coaches and pharmacists can answer member questions about a medication side effect, conduct drug interaction safety checks, and empower members to better manage their health. Our systems provide a 3600 view of a member’s complete health record using an integrated dashboard that crosses medical and prescription drug benefits. This is particularly useful for members with chronic diseases, where treatment compliance is crucial and interventions are often time‑sensitive and complex. Many carve‑out vendors cannot provide this level of wrap‑around care — particularly for medically fragile members.
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By providing holistically integrated medical and prescription drug benefits, Independence makes use of complementary resources that enhance the overall delivery of health care. Although this helps control drug costs and ensures access to necessary treatments, it also optimizes health care outcomes by promoting continuity of care and increasing member engagement in health care decision‑making.
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Industry trend to watch: Eczema
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There has been a surge of activity in drug development for atopic dermatitis. While new treatments may offer more effective options for patients, they will come at a high cost.
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Read more in an article about eczema from FutureScripts®, which outlines some of the recent activity and key issues around treating this widespread condition.
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