PHARMTrac Applications

Group Health - Public Funds

• 5% Medicare/Medicaid patients are responsible for 50% of the total expenditures of public funds with hospitalization being the most costly expense
• PHARMTrac's monitoring of patient prescription drug use in an outpatient setting is the most cost-effective means for reducing hospitalization
• PHARMTrac can identify high risk patients and refer these patients to a disease management program
• PHARMTrac can monitor and control costs for Aids patients
• PHARMTrac can monitor and improve costs and management for mental health
• PHARMTrac can, in conjunction with a referral management/ordering system, such as STATOS, coordinate home health visits, treatments, and supplies

In addition to these patient care issues, OBRA-90 mandates all states to provide baseline information, evaluation, education, and communication services that are well suited for PHARMTrac’s capabilities.

Group Health - Private Sector

• PHARMTrac can monitor an unlimited number of contracts for cost and clinical compliance
• Costs can be segmented and results forwarded to the responsible party, enabling the use of a single card for both an employer's group health and injury management.
• PHARMTrac can optimize patient outcomes and/or provider protocol compliance
• PHARMTrac can provide peer review for providers as well as plan administrators
• PHARMTrac can be utilized in disease management programs to identify early high risk and/or high cost patients
• PHARMTrac can manage carve outs of high cost or specialty programs such a
  • i. AIDS
  • ii. Mental Health
  • iii. Auto Accidents

Other: Traditional DUR can now drive interventions

Real-Time DUR reports

• Claims itemization
• Rejected claims
• Claims analysis by Physician, Drug, Patient, Pharmacy, etc.
• Real-time drug use patterns and identifying suitable candidates for mail order or those warranting drug abuse investigation/review
• Generic usage by patient, drug prescriber, and pharmacy
• Indications of abuse can be identified and tracked much earlier than traditional reporting methods.
  
  

PHARMTrac in Disease Management

Disease Management is a cost-management strategy that identifies and supports the most costly patients to a payer.

• PHARMTrac can be programmed to play a pivotal role in disease management:
  • Identify potentially high medical cost patients
  • Monitor drug use for disease management patients

PHARMTrac in Injury Management

PHARMTrac generates significant savings for injury management. by making certain that the drug prescribed is appropriate for the injury, does not interact with existing or concurrent prescribed drugs, is being properly utilized and that the price of the drug is in compliance with the contract.

PHARMTrac can

• Analyze historical claims and suggest rules for managing claims in real-time
• Screen out prescription claims which are not clinically supported by the compensible diagnosis
• Create savings ranging from 15-22% of total expenditures
• Provide a real or near real-time audit trail for all supply chain activity
• Identify potential or actual drug diversion
• Easily integrate into a rehab or back-to-work program
• Perform DUR checks from multiple PBM's on a single patient
• Stop group-related maintenance medications from being cost shifted to worker's comp because of improper pharmacy billing
  

Reports

PHARMTrac real-time reports provide a true management tool rather than an excuse tool.