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Part D Plan Perspective on Serving Dual Eligibles

Published byMeagan Hardy Modified over 6 years ago

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Presentation on theme: "Part D Plan Perspective on Serving Dual Eligibles"— Presentation transcript:

1 Part D Plan Perspective on Serving Dual Eligibles
Bob Donnelly June 6, 2006

2 Agenda Introduce MemberHealth
Discuss importance of duals and low-income beneficiaries to plans Identify MemberHealth initiatives to serve duals and low-income beneficiaries

3 Who is MemberHealth? Founded in 1998, located in Solon, Ohio
PBM and provider of specialty insurance products administering benefits for almost 5 million lives in the public and private sector Processed 12.2 million scripts in 2005 – project over 40 million in 2006 60,000+ pharmacy network Top company in Weatherhead 100 for 2005 Experience with Medicare Drug Discount Card One of 10 national PDP sponsors – 4th in enrollment as of 4/18 Sponsor of Community Care Rx plan

4 Community Care Rx Strong partners – CSC and NCPA
Auto enrollment in 23 regions Broad network Broad formulary Aligned incentives Focus on strong relationships between pharmacist and enrollee

5 Importance of Duals/LIS to Plans
14 million duals and LIS eligibles – one third of all Medicare beneficiaries Auto-enrollment mitigates selection concerns Risk adjustment should limit risk associated with higher costs for duals Majority of CCRx enrollees are duals/LIS Need to keep costs in line and provide good service to keep dual/LIS enrollees

6 MemberHealth Initiatives
340B facilities Drug review as part of transition Medication Therapy Management Outreach to States Exploring ways to help with LIS applications

7 MemberHealth and 340B Facilities
340B facilities are an important resource for duals – 340B facilities serve significant numbers of dual-eligibles MemberHealth did extensive outreach to 340Bs to explain Part D and include them in our network Created specific contract terms to account for 340B program Over B facilities are now part of our Part D network

8 Welcome to CCRx Medication Review
Part of transition plan Face-to-face review of new enrollees’ medications with community pharmacist Address both clinical and cost issues Initiate exceptions processes if needed No cost to enrollee For any new enrollee after June 1

9 CCRx Medication Therapy Management (MTM)
Focused on Pharmacist-Patient Relationship Delivered through new industry communications system – Community MTM Services, Inc. Larger opportunity for Medicaid programs to connect with pharmacists to improve patient care management

10 CCRX MTM Program Qualified Patients Receive:
Complete medication review with their pharmacist Resolution of identified clinical issues Review of appropriate cost-saving opportunities Hardcopy personalized “Patient Medication Record”

11 Financial Information

12 Clinical Alerts

13 Allergies/Conditions

14 Medications

15 Patient Education

16 Protocol Library

17 Outreach to States Getting to know insurance regulators
Separate focus on Medicaid agencies: Make sure Medicaid authorities know who we are and how to work with us to resolve issues Get Medicaid agency input on how to serve duals most effectively

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