Meritain Health® - In the Booth

Meritain Health discussion on COVID-19 and Pharmacy

April 16, 2020 Meritain Health Season 1 Episode 6
Meritain Health® - In the Booth
Meritain Health discussion on COVID-19 and Pharmacy
Chapters
Meritain Health® - In the Booth
Meritain Health discussion on COVID-19 and Pharmacy
Apr 16, 2020 Season 1 Episode 6
Meritain Health

We are pleased to share a new podcast discussing Meritain Health’s response to COVID-19 and how pharmacy is impacted. 

Key points include:
Utilization Patterns – We are tracking the utilization patterns of pharmacy as a result of COVID-19 from a holistic perspective around total cost of care. 

Refill Too Soon edit relax – Members with active eligibility may obtain an early refill of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy. The refill obtained will stay consistent with the standard days’ supply previously filled by the member as allowed by their plan.

Prior Authorization (PA) Extension – extending PAs that are set to expire on or before June 30th for 90 days. This will apply to Formulary Exception and Clinical PA records; including Specialty. This will ensure continuation of critical drug therapies and eliminate the need for members to go to their prescribing physicians for prior authorization renewals.

Quantity limits – To address potential stockpiling, ensure proper utilization and to help address potential supply chain shortages, we have worked with our PBM partners to implement quantity limits on certain drugs. Quantity limits are designed to address safety and to ensure that the correct amounts of medications are dispensed. 

Support– Meritain Pharmacy Solutions Service Management, Strategic Account Executive and Clinical Teams are on the front line and accessible to address any/all escalated issues related to member prescription issues. 

Show Notes Transcript

We are pleased to share a new podcast discussing Meritain Health’s response to COVID-19 and how pharmacy is impacted. 

Key points include:
Utilization Patterns – We are tracking the utilization patterns of pharmacy as a result of COVID-19 from a holistic perspective around total cost of care. 

Refill Too Soon edit relax – Members with active eligibility may obtain an early refill of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy. The refill obtained will stay consistent with the standard days’ supply previously filled by the member as allowed by their plan.

Prior Authorization (PA) Extension – extending PAs that are set to expire on or before June 30th for 90 days. This will apply to Formulary Exception and Clinical PA records; including Specialty. This will ensure continuation of critical drug therapies and eliminate the need for members to go to their prescribing physicians for prior authorization renewals.

Quantity limits – To address potential stockpiling, ensure proper utilization and to help address potential supply chain shortages, we have worked with our PBM partners to implement quantity limits on certain drugs. Quantity limits are designed to address safety and to ensure that the correct amounts of medications are dispensed. 

Support– Meritain Pharmacy Solutions Service Management, Strategic Account Executive and Clinical Teams are on the front line and accessible to address any/all escalated issues related to member prescription issues. 

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BC: Thank you for joining me for another special edition of In the Booth today. My name is Bridgette Cassety and I'm in the broker engagement department here at Meritain. And today I am joined by two of my colleagues, Don Bishop, who is head of our pharmacy clinical management team. And Jeremy Wisniewski who's head of Meritain pharmacy solutions. So thank you both for joining me today and having a conversation around pharmacy related issues many people have on their minds related to COVID19 so Jeremy, I thought I'd kick off our conversation today with you and sort of get your perspective as the head of our pharmacy solutions area here at Meritain and give us some indication of just what you're seeing in the pharmacy space right now related to the utilization patterns of our members and how that's impacting cost. Just to share with our listeners. So could you kick us off and maybe give us some perspective of what you're seeing from your position at our company? JW: Yeah, absolutely. You know, it's a great question. It's a question that I think a lot of folks are, are asking and frankly it's one that we have been asking ourselves, we continue to track the overall utilization patterns that we're seeing within our book. And it's been such a fluid situation. The same as what we're seeing in, you know, in our own personal lives around us is the same thing that we're kind of seeing within the space itself. So it's almost too new still to truly understand how things are going to be impacted. We have some anecdotal ideas of, you know, lower office visits because people are staying at home or whatnot and lower office visit should equate to, you know, lower prescriptions, things being prescribed, which he'll turn into a lower utilization of, of drugs. All right. So, but again, it's right now it's all anecdotal, so stuff that we're trying to dig into, but I don't know that we necessarily have a good read yet on how the industry is going to be impacted from COVID just yet. BC: So Jeremy, when you say that then, is it reasonable for people to think about that even if utilization patterns have shifted a little bit on pharmacy, that overall the total cost of care impact could not be maybe what people are thinking it would be? JW: No, absolutely. I think the big question that people keep asking is how's it going to impact my costs, A. And B, what is being done to make sure that, that we still have access to our drugs. That there's, there's, you know, the right controls that are being put in place to ensure that people can still get their prescription. In terms of the total cost of care, one of the things that we're seeing is actually more folks, you know, leaning towards things like a maintenance choice and your 90 day retail scripts and your mail order, those things actually help to improve total costs of care because they lower the overall price of the scripts that are being filled. In terms of the kind of the key things that we're doing to ensure that there's the right access for folks. I think that's a great place where we bring Don into the conversation as the head of our in a clinical management department. Those are the things that he and his team really focused on to ensure that our, our members that have access to medication. BC: I think you're right, Jeremy and many of our listeners may have talked to Don in the past and Don Bishop has been with the organization for a long time has interacted with a lot of our customers and brokers and Don is one of our clinical pharmacists that we have on our team here at Meritain. So Don, I think that's a great segue that Jeremy has provided for you to maybe give us some perspective. You know, certainly there's a lot of concern around accessibility of medication during this very critical time. So could you sort of talk with our listeners a little bit about what we're doing at Meritain pharmacy solution in order to ensure accessibility so that we don't have adherence and breaks in people taking their medications? DB: Absolutely. And thank you so much for this opportunity. Well as the pharmacy benefit manager for Meritain, we actively work with our backend partners. We've got partners, partnerships with CVS, Optum RX and with express scripts and we work with them to ensure that our plan members have access to their prescription medications. Now, each of our PBM partners, they have emergency preparedness plans and business continuity plans in place to ensure that there's adequate drug supplies and coverages for our members during the time of crisis. Obviously following with state and local guidelines and during times of national natural disasters, like with hurricanes and tornadoes and fires, we've worked with our PBM partners to make sure that all of our plans and benefits and our pharmacy claims systems edits are adjusted to meet the needs of our members. So the COVID 19 crisis is not the very first time that we've had to respond to an emergency. As such, we do this on a regular basis, but this time it's just a little bit more broad, broad and it's a little bit bigger because it's supplying across the board and across the U S and to that end we've made a couple of adjustments to our claim systems that I wanted to talk about. The first of all is refilling the prescription too soon, the refill edit too soon. What we've done is we've, we've relaxed that edit so that members who have active eligibility and active prescriptions can obtain an early refill on their prescription medications, so if they need to get a refill and it's earlier than they normally would. They're still able to go and get it so that they can have enough day supply and enough medication to last throughout this time frame. The second thing is with the prior authorizations, we've extended our prior authorizations that have set to expire on June 30th for 90 days. And what this does is allows those formulary exceptions and those clinical pharmacy PA or prior authorization records including specialty drug records to be extended. And this will ensure the continuation of critical drugs, therapies and eliminate the need for a member to go to the prescribing physician to try to obtain a prior authorization renewal. Again, our goal and our job is to make sure that the systems are in place and the edits are in place or we relax those edits so that there is no, the members are not stopped with getting their medications. BC: Don, I think that's great information for you to share with our listeners and as I listened to you talk something that certainly crosses my mind is certainly you're, you're putting the emphasis on access which is so important when it comes to pharmacy benefits and certainly there's a lot of comments that are being made about stockpiling of medications and how that impacts availability of medications for members that use them on a regular basis. Are we seeing any of that in our space and if we are, what are we doing to manage that to preclude it? Could you talk a little bit about the that? DB: Absolutely. There've been some questions around medication accessibility and whether drugs will run out or whether members are able to stockpile medications. What we've done, in addition to the two things that I just talked about in terms of relaxing our refill too soon, edits and prior authorization extensions, we've also put in quantity limits on certain drugs that are available within the marketplace. So what that does is it gives us an opportunity to address safety and also to ensure that the correct amount of medications are being dispensed because we don't want there to be stockpiling and we don't want medication shortages. In addition to that we’ve received questions around potential exposure for pharmacy personnel and members as well as delivery workers around signature requirements when medications are being taken up at the pharmacy or they're being delivered. What we've also done is confirmed with our PBM partners that signature requirements are also being waived for delivery and for picking up prescriptions at the time of a refill or the time of the prescription being filled. This does not, however, apply to controlled medications. Those will still be subjected to the signature requirements. So, and finally Meritain pharmacy solutions, our service management team, as well as our strategic executives and our clinical teams are on the front line. We are accessible and available and we are ready to deal with any escalated issues so that if there is an issue that a member's having at the pharmacy, the pharmacist can get through to us and we can address those issues accordingly. Again, it's all about ensuring that there's complete total coverage and that our members have access to their medications as we all work together to address this COVID crisis. BC: Thanks Don. Things what I take from the conversation that we've had here today with Jeremy and with you that you think that sort of stick out in my mind that, that our key themes are that, you know, we're not really sure what the utilization patterns are yet as a result of COVID 19 as it relates to pharmacy. However, we're sort of tracking that holistically and saying we're looking at that from a holistic perspective around total cost of care. So I think that's something Jeremy, that you really talked about that that is an important for people to keep in mind. And then Don, I also heard you say that, listen, this isn't the first time something like this has happened. It's a little bit broader, but we're ready, we’re prepared. We have systems in place to make sure that members have access to their medication. And a couple of things that you touched on were the early refill, the prior auth extensions and the quantity limits just to make sure that there's not a disruption in the supply chain for medications that people need. I think most importantly though, what you said Don, is that we're available, right? So if we have a member or plan sponsor or a broker that is encountering some challenges around making sure that our members are taken care of that were available to assist. And I think that's an important message for our listeners to hear as well. And with that, I want to thank both Don Bishop and Jeremy Wisniewski for joining me today for this special edition around COVID 19 and I look forward to joining you again with another special edition related to this topic. Thank you and have a great day.