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Rx Health AdvisorSM on Target for January 2012

November 17, 2011

Effective Jan. 1, 2012, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will be launching  Rx Health Advisor, a medication therapy management (MTM) program which will help you ensure appropriateness, effectiveness, safety, and proper use of medications prescribed to our insured business members. Rx Health Advisor also will help promote cost-saving opportunities, such as generic alternatives, increased utilization of mail order services and enrollment in the specialty pharmacy program for members with chronic conditions.

Together with Prime Therapeutics, our pharmacy benefit manager, we are collaborating with MEDecision to implement a systems platform that will identify members who may benefit from Rx Health Advisor. Utilization information from a member’s medical and medication claims history will be assessed to help identify potential drug therapy issues, such as:

  • Usage of excessive medications, or polypharmacy (multiple prescription drug claims from various prescribers or filled at different pharmacies)
  • Duplicate drug therapy
  • Potential drug-to-drug interactions and complications
  • Mismatch between prescribed drug therapy and documented medical condition

Once members with potential drug therapy issues are identified, the program will facilitate clinical pharmacist outreach to prescribing physicians. Here is how it will work:

  • When a member with potential drug therapy issues is identified, the prescribing physician will be contacted by the Rx Health Advisor pharmacist.
  • This contact will include suggested recommendations for the physician’s consideration to address the issues noted.
  • All MTM program information is provided to assist the physician in managing their patient’s care, and is not intended to replace their clinical judgment.

PILOT PROGRAM IN PROCESS

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSOK contracts with Prime Therapeutics, a separate company, to provide pharmacy benefit management and other related services. BCBSOK, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSOK contracts with Prime Therapeutics, a separate company, to provide pharmacy benefit management and other related services. BCBSOK, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.