The prevalent use of powerful, addictive narcotics in the healthcare system is a major driver of Rx costs. Prescription drug overuse increases claim costs, claim durations, and puts patients at risk of overdose and addiction.
The Benefits of Taking Action
¸é¾±²õ¾±²Ô²µâ€™s Physician Pharmacy Review program takes action on drug misuse and abuse, so you can:
- Decrease the time and manpower needed to identify at-risk cases
- Act early and proactively
- Reduce addiction potential
- Improve patient health outcomes and productivity
- Increase return-to-work probabilities, for workers’ comp cases
- Cut prescription costs
5 Steps to Early Intervention
Avoid unnecessary expense through early detection of questionable prescription usage behavior. Rising intervenes with five proven steps that reduce your claim costs.
Step 1: Rx Intelligence
Our award-winning Rx Intelligence pharmacy analytics flag your at-risk cases by tracking prescription activity, including:
- Fill dates
- Number of fills
- Usage days
- Average fill interval days
- Dosage amounts
- Urine drug screenings
- Costs
- Prescriptions from multiple providers
- Escalation and weaning patterns
Step 2: Nurse Drug Evaluation
Rising nurses alert you to cases that may benefit from a Physician Pharmacy Review.
Step 3: Physician Pharmacy Review
Our pain management physician reviewer contacts the prescribing physician with recommendations (i.e. medication alternatives, frequency, dosage and/or a weaning program).
Step 4: Tracking
¸é¾±²õ¾±²Ô²µâ€™s Rx Intelligence technologies track the case to assess positive improvements.
Step 5: Telephonic Case Management (optional)
¸é¾±²õ¾±²Ô²µâ€™s telephonic case management can be used to ensure the physician reviewer’s recommendations are implemented.
5 Key Questions to Ask About Your Pharmacy Evaluation Program
- Does it provide a complete medical picture or is it limited to prescription fill information?
- Is it proactive and actionable? Does it identify questionable activity early in the claim?
- Are drug screens included in your dataset, and does your solution show if drug screens are being over or underused?
- Does it show the prescribing activity for all drugs, not just opioids, and identify escalation or weaning patterns?
- Can you easily see prescriptions from multiple providers?