How We Save On Benefit Costs

Smart plan designs to manage costs

genericDrugsEveryone is looking for a way to manage drug plan costs.  Our clinical approach to pharmacy benefits management will help you reach your business goals.

Plans that are based on quality pharmacy care and improved outcomes with appropriate drug use management will result in long term savings and deliver real value.  Based upon our experience, you’ll see quality of life increase, treatment outcomes improve, plan member satisfaction rise and total medical costs decrease.

Plan Management

There are four cornerstones to the management of our Drug Benefits Services:

  • Cost
  • Utilization
  • Care
  • Outcomes

How We Manage Costs

There are some factors that drive costs which are out of your control, such as aging population and new drug development. However, deciding who provides the service, how the plan is delivered and how the benefit is priced is within your control.

Consider the following:

  • Savings on administration and claim costs through Preferred Network drug card solutions
  • Optimized generic fill rates (GFR)
  • 90 day supplies of maintenance medications
  • Customized plan designs and formularies that meet your needs
  • Administration Services Only (ASO) benefit design where appropriate
  • Risk management products to meet your needs
  • Integrated supply chain management
  • Incorporated mail-order solutions

How We Manage Utilization

Optimal utilization means that people get the right medication at the right time and at the most cost-effective price. We do this by using the full capacity of our on-line adjudication system coupled with the expertise of our “frontline” pharmacy professionals.

Strategies used by MHCSI to achieve this include:

  • Therapeutic substitution protocols
  • Trial prescriptions on new-to-you medications
  • Comprehensive audits and drug utilization review
  • Adherence monitoring and support services
  • Individualized medication assessments
  • Targeted therapeutic interventions
  • Preferred agent listing and tiers

 How We Manage Care

Proper use of medication is integral to the management of many chronic health conditions, such as high blood pressure, diabetes, asthma, and so on. To ensure that you get good return on your investment in medications, we provide access to the following services at our provider pharmacies:

  • Disease state management programs
  • Individualized medication reviews
  • Customized care plans
  • Appropriate use of prior authorization protocols
  • Formulary design management
  • Adherence monitoring and support

How We Manage Outcomes

At MHCSI, we believe that workplace wellness initiatives should focus on promoting communication, education and empowerment to support not only healthy members, but also productive and thriving organizations. To this end, we are pleased to offer the following types of wellness programs on a wide variety of topics to our clients at preferred  rates:

  • Individual general health risk assessments with aggregated group analysis
  • Onsite biometric screening clinics
  • Onsite flu vaccinations
  • Smoking cessation programs
  • Education seminars on a wide variety of health topics (nutrition and diabetes are popular requests!)
  • Annual reviews of aggregate drug utilization, including therapeutic profiling plus customized recommendations