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Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 1 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL.

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Presentation on theme: "Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 1 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL."— Presentation transcript:

1 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 1 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. County of Los Angeles Pharmacy Program Overview October 2011

2 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 2 What We’ll Discuss  Why Express Scripts for Workers’ Compensation (WC)  Overview of the Pharmacy program  How the program controls cost  Capturing First Fill and On Going prescription needs  Formulary and Clinical programs  Safety for patient  Prevents fraud and abuse  Resources for you and your claims handlers  Program support

3 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 3 Workers’ Compensation Industry Leader Nationwide Workers’ Compensation pharmacy network Workers’ Compensation injury-specific formularies Aggressive paper bill solution Industry-leading technology Clinical Advisory Committee to ensure clinical program effectiveness Leverage clinical experience to offer improved outcomes and savings Serve the injured worker while driving to the lowest net cost Express Scripts ensures safety for your injured workers, while aggressively reducing waste

4 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 4 Drive Out the Waste Ease of administration and process efficiencies further drive savings

5 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 5 Comprehensive Pharmacy Program Proven pharmacy solutions delivering safety, savings, and satisfaction Our solution is a complete package for Workers’ Compensation Core Services Trend Programs Clinical Programs

6 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 6 How Prescription Gets Filled CORE SERVICES

7 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 7 Script can be filled before the claim is reported – 14 Day Supply Eligibility 1- Work Comp Acute Drug List 2- Standard List for Ongoing Needs Formulary Management Assures that non-formulary medications are identified and sent for approval Prior Authorization Best practices in each key operation drive safety, savings, and satisfaction Value of First Fill Form

8 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 8 First Fill Form

9 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 9 Nationwide Pharmacy Network  Express Scripts’-owned network is contracted directly with pharmacies, specifically for workers’ compensation  More than 57,000 pharmacies nationwide  Includes major retail chains in Los Angeles County Wal-Mart Target  Express Scripts will recruit additional pharmacies to meet your needs  Contracting standards – urban area within 1 mile – suburban with 5 miles and rural within 15 miles Express Scripts’ goal: a network pharmacy within one mile of an injured worker Rite AidAlbertsons CVSRalph’s Pharmacy

10 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 10 Core Services Dedicated Workers’ Compensation resources and capabilities  Formulary Management  Account service team  Patient care contact centers  Home delivery pharmacy  Reporting

11 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 11 Clinical Programs  Concurrent Drug Utilization Review  Retrospective Drug Utilization Review  Physician Outreach Program  Step Therapy  ScriptAlert  Pharmacist’s Drug Review (PDRx) Increasing safety and clinical effectiveness

12 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 12 Clinical Programs Drug Utilization Review Concurrent DURRetrospective DUR Goal of reviewDeter fraud and abuse and increase patient safety Review occurs At point-of-serviceAfter script is filled Corrective action Dispensing pharmacist alerted Physicians alerted on findings Designed to ensure injured worker safety

13 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 13 Delivering Savings to Clients Physician Outreach Program Goal: Decrease use of brands and increase generics being dispensed Delivering Savings to Clients

14 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 14 Trend Programs Step Therapy (effective 1/1/12) Encourages use of generics before more costly brand-name alternatives

15 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 15 Clinical Programs ScriptAlert Reporting We identify potentially high-risk claims Send Monthly report Client can take appropriate course of action Aggressive case management Independent medical examinations Physician or peer-to-peer conversations Enabling Patient Safety

16 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 16 Clinical Programs Pharmacist Drug Review (PDRx) Submit request with all pertinent medical records Request 1 Review 2 Licensed pharmacist reviews injured worker’s complete medical file Report 3 Clinical assessment conducted to: Identify specific drug therapy problems Offer recommendations Propose desired clinical outcomes

17 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 17 Resources

18 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 18 Contact Center Pharmacy assistance, new claims, eligibility updates, medication approvals, etc. Call 24/7 at or Client Support Center (CSC) Escalated pharmacy and eligibility requests Call Monday – Friday 5:30 am-5:30 pm (MST) at or Mail Conversion Center (MCC) Assistance with converting injured workers’ scripts to Home Delivery Call Monday – Friday 7:30 am-5:00 pm (CST) at or Account Management Support Assist with program changes and escalations beyond above teams or ext or ext. Express Scripts Resources

19 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 19 Drug Information  Evidence-based website  Drug information  Drug interactions  Generic availability  Approved indications (reasons for use)

20 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 20 Adjuster Tools

21 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 21 Alignment with County of Los Angeles Our program is designed to meet your business objectives Safety Savings Satisfaction

22 Greater Care. Zero Waste. PROPRIETARY AND CONFIDENTIAL © 2011 Express Scripts, Inc. All Rights Reserved. 22 Express Scripts Workers’ Compensation Your perfect pharmacy solution for injured workers


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