Coordinated Care Management

February 14, 2012

Medco's Medical Benefit Management Program Provides Coverage and Easy Management of Specialty Drugs

A new medical benefit program from Medco Health Solutions, Inc will allow increased coverage for specialty medications that are covered under major medical plans.  Along with its subsidiary Accredo Health Group, Inc., Medco has made it possible for a number of clients to move to the pharmacy benefit plan for coverage of speciality drugs thereby enabling improved management of costs. The new medical benefit management initiative will provide enhanced cost transparency to health plans and enable employers to continue carrying on with coverage of specialty drugs under their respective medical plans.

In a release, Frank Sheehy, president of Accredo, said, "We developed this program in order to extend the best practices in specialty pharmacy to major medical coverage. Historically, health insurers and other payors have not focused on the prevention of waste or the management of specialty drugs that fall within the medical benefit. This has cost them an estimated $8 billion annually from lack of compliance, over-utilization, non-formulary drug use and other inefficiencies. We are offering to reduce an administrative burden for health plan sponsors, while also providing an elevated standard of care."

Medco will be leveraging the NovoLogix software to provide the necessary foundation inside Medco's medical benefit management program. Medco will be responsible for developing medical policy, formulary and coverage rule management, prior authorization, as well as management of claims for clients. The program will handle patient coverage regardless of whether the coverage was provided by Accredo or a physician’s office or an outpatient establishment. Since a number of these drugs can cause side-effects the need for increased interaction between the patient and the clinical team providing care is necessary.

David McLean, CEO of NovoLogix, said, "We are very excited about our partnership with Medco. We will provide our technologies and experience in this program with Medco to bring significant value to health insurers and payors to help stem the double digit cost trends that plans and patients are experiencing."

Most major medical plans provide limited channel management for specialty drugs.  Because the annual cost of these drugs is extremely high and rising, Accredo ensures that these medicines are properly used so as to avoid or limit waste. The company also coordinates coverage plans and engages with clinicians over care provided to patients receiving specialty drugs.

Calvin Azuri is a contributing editor for HealthTechZone. To read more of Calvin’s articles, please visit his columnist page.

Edited by Rich Steeves
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