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Program Structure – Patients

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Patient Program Structure

MedicoRx® Specialty Patient Program Overview

As health care providers, pharmacists share your goal of helping patients to achieve the best possible outcome from their prescribed therapy. Pharmacists are ideal partners to work with prescribing therapy. Pharmacists are ideal partners to work with prescribing practitioners to meet this objective by working with patients to increase their understanding of the drugs that were prescribed, and their role in getting the best possible results.

Our high-touch, patient-centric Specialty Management Program strives to ensure appropriate medication utilization, compliance, and adherence.  We offer disease state specific programs which are patient and therapy specific via CPR+ patient records program, Therigy STM, and MHA CTM; offering members support and education for controlling side effects, promoting adherence to therapy; offering specialized handling and distribution of medications per protocol.

The foundations of this comprehensive program are:

MedicoRx® Specialty Utilization Management Program

  • Personalized case review by a licensed pharmacist
  • prior authorizations
  • Quantity dose review
  • Dose optimization
  • Drug Utilization Review (DUR) on every prescription
  • An Array of Co-pay assistance program offerings

Utilization management evaluates the appropriateness, necessity and efficiency of the prescribed medications, based on most current established criteria or guidelines. This is performed on initial referral, prior to all refills, and when any side effects or adverse events are reported. Our utilization management programs aim to provide accessibility, education, and comprehensive guidance to physicians.

MedicoRx® Specialty Personalized Case Review and Prior Authorization

Our clinical experts offer comprehensive case reviews and assist in prior authorization (or pre-certification) services that serve as a vital part of the overall clinical and cost management of specialty medications.

We work with our patients and doctors directly to determine medical necessity requirements, adapt our existing guidelines to meet individual needs, and incorporate plan-specific criteria as necessary via our specialized MTM programs. Furthermore, we can work directly with health plans and physicians to assist in communicating authorization requests and obtain plan approval prior to dispensing.

Case review is a highly recommended process to promote appropriate medication use that is consistent with the benefit. Case review is a vital part of the overall clinical management and cost management. Case review is accomplished through a dedicated team of clinical staff interacting by phone, email, and/or fax with the requesting physician offices. For eligible members and covered services, cases are reviewed using evidenced-based guidelines. A clinical pharmacist solidifies all specialty medication case review decisions.

Using evidence based literature, we also support development of clinical recommendations based on suitable guideline criteria and communication of industry updates as new drug therapies emerge on the market.

Case review and authorization services offered by Medico RX Specialty Pharmacy are accomplished via a dedicated team of clinically licensed pharmacists and pharmacy personnel who interact with physician offices and/or the patient or health plan contacts.

MedicoRx® Specialty Co-Pay Assistance Referral Program

As continuity of therapy is crucial with specialty medications, we understand the need to eliminate breaks in therapy. In order to avoid interruptions, we can assist and refer qualified members to specific targeted programs that offer co-pay assistance.

MedicoRx® Specialty Collaborative Prescription Fulfillment Program

  • Phone-based outreach and coordinated same or next-day deliveries for patient convenience
  • Deliveries are made at the member’s or physicians location of choice
  • Inclusion of supplies when warranted

Working directly with the patient, caregiver and/or provider to ensure that medications are delivered in a timely manner, as scheduled and temperature controlled per specific therapy requirements to ensure proper administration is the core of our prescription fulfillment program.

  • Coordinating the shipment with the patient and physician to the location of choice
  • Providing temperature controlled, same or next-day delivery
  • Tracking shipments to ensure successful delivery
  • delivery notifications directly to patient/provider
  • Distributing patient educational materials
  • Providing necessary ancillary supplies (sharps container, bandages, gauze, alcohol swabs, needles) as needed

MedicoRx® Specialty Medication Compliance Program

  • Proactive refill reminders and side effect management by phone to encourage compliance
  • Provider notification if compliance issue is identified
  • Mobile app/texting/ dose reminders
  • Unit-dose packaging (med strips, blister packs, timer caps)
  • Adherence monitoring, measuring, and reporting (medication possession ratios)

Medication compliance is crucial to the effectiveness of a member’s treatment program for a chronic disease. Our medication compliance program helps patients stay on track with their physician’s prescribed medication regimen.

Our patient care coordinators call the member prior to each scheduled refill and coordinate his or her next prescription delivery. Up to three phone attempts are made prior to the member’s scheduled refill date. If we are unable to reach the member though these calls, we place a follow-up call one week after the scheduled refill. We then notify the member’s physician if there is no contact or follow-up from the member.

MedicoRx® Specialty Condition Management and Education Program

  • Free educational materials sent to members and providers
  • Newsletters available for certain conditions
  • Information available on website

Member education is a key part of a successful specialty pharmacy program. Well-informed members can better manage their chronic conditions, and are more likely to adhere to therapy and make healthy lifestyle choices. This can result in improved member outcomes and satisfaction and reduced catastrophic medical events, absenteeism, and overall health care costs. Curriculum currently consists of over 20 conditions or medication based education topics.

MedicoRx® Specialty Patient Management Program

  • Available for Hepatitis C, Rheumatoid Arthritis, Oral Oncology, IVIG, and High risk patients.
  •  Free phone consultations with our trained clinicians
  • Individualized care plan for targeted disease states
  • Ongoing case management and follow-up with patient, physician, and caregiver where applicable

Our Clinical management program provides structured educational and clinical support for patients to help improve adherence, appropriate utilization, and ensure optimal outcomes. Our Clinical Management Programs are a value-added program, available to clients and members at no additional cost. Patients can choose to opt-in, opt-out or discontinue from service at any time.

Pharmacy Patient Management Program Overview

Pharmacy Patient Management Program is designed to help patients remain compliant with their medication therapy through individualized support, communication and education on targeted disease states, promoting better health and wellness. We currently support Pharmacy Patient Management Programs for hepatitis C, IVIG patients, high risk patients, and rheumatoid arthritis.

MedicoRx® Specialty Patient Services

Our MTM program services for patients include, but are not limited to, the following:

  • One-on-one phone consultations with a registered nurse or clinical pharmacist
  • Personalized care plans highlighting the key issues, goals, and outcomes discussed during the consultations
  • System management tips related to the medical condition and side effect management
  • Reference for additional resources provided by CPR+, Therigy STM, MHA CTM, and any other resources that may be of value
  • Refill reminder calls and follow-up calls as needed or as requested by patient/prescriber
  • Proactive identification and intervention for at-risk members for medication non-adherence via our high risk patient care program.