Prescription Benefit Management
Prescription Drug Card Program — Plan Design
Customized Plan Solutions
Universal Rx's customized plan solutions, which begin with consultation services and can include customized diabetes management, mail order pharmacy services and retail utilization management, are designed to lower your members' prescription drug plan costs while improving the quality of care they receive.
Consultation Services
Members look to their employers for new ways to control rising drug costs without sacrificing their prescription benefits and quality of service. They also look for customized programs that are geared toward their special medical needs. More importantly, they demand high quality service for themselves and their family members.
Universal Rx provides pharmacy benefit consulting support so the plan can choose the best total-cost solution for their organization and also provide benefits focused on the desires of their plan members. Universal Rx is able to access benchmark data to help our clients understand current utilization and solutions that can improve current plan performance and reduce costs.
Plan Design: Therapeutic Categories
Universal Rx offers consultation to our clients during the plan design set up phase on all aspects of the plan. One of these aspects is which therapeutic categories the plan wishes to make covered and what therapeutic categories the plan wishes to make non-covered. Once this is established, Universal Rx then works with the group to set up guidelines if a scenario such as an appeal or pre-approval occurs. Universal Rx can be as flexible or as firm as the plan wishes.
If the plan determines they do not wish to cover a therapeutic category but determines later they would like a specific medication covered for an individual plan member, Universal Rx can place an override into our database allowing that medication to be covered for that plan member. Overrides can be entered to supersede any plan design intricacies. Universal Rx offers the plan flexibility; allowing the client to change a therapeutic category and/or a specific drug to be covered or non-covered for all or individual plan members at any time.
Diabetes Management Program
On average, 12% of the total annual costs of medical care goes directly to diabetes care. Average medical claims for members with diabetes cost nearly three times as much as claims of enrollees without diabetes. Diabetes complications, such as kidney disease, contribute greatly to total healthcare costs, although these may not fall under the diabetes diagnosis code.
Benefits Include:
- Flexible Program Design to Meet Members Individual Needs and Existing Diabetes Initiatives
- Increased Knowledge of Diabetes Self-Management for Members
- Assistance in Controlling Costs Associated with Diabetes Management
- Increased Compliance in Member Population with Diabetes Care Guidelines
- Outcome Reports that Assist Plans in Directing Intervention Resources
Universal Rx has partnered with Liberty Medical to provide members access to low-cost diabetes supplies and specially trained representatives that provide education on living with diabetes.
Mail Order Pharmacy Services
Mail Order Pharmacy Services were developed to provide information, quality, and service as close to the retail setting as possible. Universal Rx provides a variety of mail order options designed to provide improved health outcomes for our members and generate substantial savings for our clients.
Service
DrugSource, our mail service pharmacy component, combines personal service with the convenience of home delivery. Pharmacists and their patients develop a close relationship over time. Being able to ask questions and to personally know the pharmacist filling their prescription is important.
Convenience
The Mail Order benefit allows employees and their dependents to order up to a 180-day supply of maintenance medications with one simple co-payment and fewer trips to the pharmacy. High-quality maintenance medications can be conveniently ordered by telephone or online.
Savings
The Mail Order Pharmacy feature provides a benefit to both clients and their members. Taking advantage of the Mail Order feature helps members achieve greater savings and convenience while saving additional costs to the overall plan.
Preferred Rx Program
As additional generic medications become available in the marketplace and the use of prescription drugs grows, the opportunity to lower healthcare costs becomes even more significant. Furthermore, using more generics simply requires better education and awareness of alternatives, not an expensive up-front investment.
The use of Brand (or higher cost TIER 3) medications is a major factor in the increasing costs of prescription drugs. Universal Rx recognizes this problem and has developed a program that focuses on steering members toward a more cost-effective method.
Universal Rx utilizes innovative reporting to identify members who are currently utilizing a high cost prescription drug when there are comparable generics available. Universal Rx then contacts both the member and the member’s physician to provide them an alternative medication option. This method is invaluable in providing savings to both the client and member as it encourages patients and doctors to be proactive in maintaining a level of responsibility to the plan.
This program has helped boost clients’ savings tremendously. This value-added service encourages patients and doctors to be proactive in maintaining a level of responsibility to the plan. The member and the plan will both save money through the Preferred Rx program.
Most plans today utilize the tiered co-payment structure. For example:
20%+$15 |
Tier 3 - Highest Cost Brand Name Drugs |
20% |
Tier 2 - Highest Cost Generic & Lower Cost Preferred Brand Name Drugs |
10% |
Tier 1 - Generic Drugs and Selected Low Cost Brand Name Drugs |
Tiered co-payment structures provide cost savings incentives to plan members to always select the least expensive medication while still providing coverage on brand name drugs; however, only the plan member contributes more on these brand name drugs.
A tiered co-payment structure also affords Universal Rx the opportunity to offer our Preferred Rx program.
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Universal Rx • 710 3rd Street • Roanoke, VA 24016 • Phone 540-777-7179 • Fax 540-777-7184 • Email urx@universalrx.com
