![]() ![]() ![]() Given our connectivity and interoperability, our specialty pharmacies use electronic health records (EHRs) to verify the diagnosis through actual patient records prior to approving the treatment. When a prescription prior authorization (PA) is first submitted for a specialty treatment most reviews are based on a simple attestation from the prescriber. ![]() This means any decisions about approval or denial of treatment are rooted in rigorous clinical standards. To help ensure the right coverage from the start, our robust utilization management (UM) criteria are developed by pharmacists, reviewed by external physicians, and accredited by third-party organizations including URAC, an independent leader in promoting health care quality through accreditation, certification and measurement. Roughly 11% of pharmacy spend is generated when a member is first diagnosed and prescribed a specialty therapy. Of clients had less than 10% specialty trendīy being connected in care, we can better engage your members and their providers to ensure the right medication is covered from the start, keep unit cost low, and eliminate waste through the duration of treatment. In addition, we intervene when needed to ensure that treatment is still working for members, and work with prescribers to change or discontinue it if not effective. Having the right interventions to detect and take action is critical to saving money. ![]()
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