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3 Cards in this Set
- Front
- Back
- 3rd side (hint)
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When choose PBM as a partner, what items must be considered?
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Options and pricing of the network
Ownership of mail order pharmacy. If not own by PBM, how is it monitored? PBM terms Transparent and auditable? Can plan sponsor unrestricted audit the claims if price guarantees offered? Service and performance guarantees? Reports that PBM offered. What kind of reports? Preferred list of drugs. How is it developed, Who develped? Can changes be made? Utilization review edits. What types? Can they be customized? Is it based on Measurable Criteria? Disease management programs. How is it designed? Funded? Education Program. To physicians and alter prescribing patterns? To patients? Ancillary services. What type? Saving and ROI? Is it the best financial arrangement? Determine the most important criteria to the plan and see if the PBM can fulfills these needs. If the most attractive PBM is not the incumbent, is the firm able to manage the change? |
先是network
透明程度 服务承诺度，提供的报表 提供的服务内容 对PLAN来说，这个选择能带来多少利润 最后检查选择是不是达标，如果不是，有没有备份方案？ |
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What techiniques does the PBM used to management utilization?
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Step therapies - Requires the use of one type of drug prior to others
Prior authorization - Pharmacist must verify certain protocol are met Dispensing Limits - Limits the quantitiy or time period so that the physician can verify the necessity of continued use of the drug |
先后顺序，提前汇报，剂量和时间限制
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What are the characteristics of a Mail order Rx drug program?
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Typically underused (member not familiar), expected to growth in future
Compete with retail pharmacies (90 days plan in retail), lower discounts, Convenience (member), Cost Saver (plan sponsor), Create value (both member and plan sponsor) Incentive to use the mail order program |
回顾过去，展望未来
现在的竞争对手 mail order的优势 为推广mail order做的promotion (incentive) |
