FirstChoice™ is the preferred pharmacy network of Southern Scripts. A Transformative Pharmacy Benefit Management Solution. Get in touch with us. The Academy of Managed Care Pharmacy's mission is to empower its members to serve society by using sound medication management principles and strategies to achieve positive patient outcomes. Prior authorization procedures and requirements for coverage are based on clinical need and therapeutic rationale. » Express Scripts customer service representatives can be reached at 800. For example, online adjudication of prescription claims by prescription benefit management companies (PBMs) and health plans has resulted in an efficient process for administering the drug benefit, however necessary and pertinent information required for drug coverage decisions is not always available via the online adjudication system. Mail order prescriptions delivered in private, secure packaging. Fax: (844) 580-3965. FirstChoice™ Pharmacy Network. Effective July 1, 2022: Express Scripts Advanced Utilization Management Program. We're ready to discuss your PA and full-service BPO needs.
Prior Authorization. The plan may require the prescriber to present evidence supporting the unapproved use or assign a pharmacist to conduct a medical literature review to search for evidence for that indication. The step therapy approach may utilize automated adjudication logic that reviews a patient's past prescription claims history to qualify a patient for coverage at the point-of-sale without requiring the prescriber to complete the administrative prior authorization review process. One major change in switching from Optum to Southern Scripts is that there are no minimums to prescription costs. Most ulcers are healed within an eight-week duration of therapy; therefore, plans may limit the duration of treatment to minimize side effects and reduce inappropriate long-term use. For example, Botox is used to treat muscular disorders, but can also be used for cosmetic purposes (e. g., eliminate wrinkles). If the cost of your prescription is less than the co-pay, no co-pay will be charged. Requiring prior authorization in a drug benefit can effectively help avoid inappropriate drug use and promote the use of evidence-based drug therapy.
We know that when it comes to pharmacy benefit management, transparency is key. An example of a situation in which more information would be needed in order to make sound, cost effective, clinical decisions would be for medications that are approved to treat more than one condition. Sign up for home delivery. This list may change, please contact Express Scripts for the most up to date information). Track prescriptions and home delivery refills. If a non-generic drug is purchased when a generic is available, you will pay the difference in the cost of the non-generic drug over its generic equivalent. In some instances, members receive their medication for as low as $. A 90-day supply of maintenance medications may be filled at Walgreens for a similar price as mail order. 2023 Excluded Medication List - NOT COVERED. At every step, Southern Scripts, working together with Trustmark, is committed to providing convenient access to prescription medications and achieve the best health outcomes possible. We have three types of pharmacy programs with SouthernScripts that save money on prescriptions: NOTE: Walgreens and Costco can only dispense 1 month medication supplies. A step therapy approach to care requires the use of a clinically recognized first-line drug before approval of a more complex and often more expensive medication where the safety, effectiveness and value has not been well established, before a second-line drug is authorized. If the plan does not cover cosmetic products or procedures, the prior authorization program would ensure that Botox is covered only when it used for appropriate medical indications.
2 Administration of a prior authorization process must take into consideration the desired outcome for the patient, the design of the drug benefit, the value to the plan sponsor, and all statutory and regulatory requirements. Lowest Net-Cost ApproachSouthern Scripts' robust clinical management program and high-performance drug formularies deliver the lowest net cost to protect plans from unnecessary expenses. Robert Navarro, p. 249. This pass-through and transparent PBM offers innovative solutions that generate meaningful savings for employers.
Concept Series: What is Prior Authorization and Why is it an Essential Managed Care Tool? So, in the same way your medical plan provides for doctor's visits, your Express Scripts prescription plan provides an easy, cost-effective way to obtain the medication your doctor prescribes. Examples of How Prior Authorization is Utilized within a Prescription Drug Benefit. One-of-a-Kind PBM Model. Express Scripts is your prescription benefit manager for the Village of Hoffman Estates' prescription drug programs. The $10 penalty will not accumulate toward the deductible or maximum out-of-pocket limit. And the good news is you can access both Express Scripts and Accredo from the Express Scripts mobile app. Hawaii Laborers' Health & Welfare Fund. They can identify and resolve the issue for you in real time. 1550 Pumphrey Avenue. Phone: (855) 225-3997. An example of an off-label use could be a physician prescribing a powerful opiate that has only been approved by the FDA to treat break-through cancer pain, in a patient that has chronic back pain.
Pharmacists in all practice settings must develop specific guidelines to ensure that the prior authorization process is administered in the most efficient manner possible, is fully compliant with statutory and regulatory requirements, and provides members, prescribers and pharmacists with an evidence-based, rational process to promote appropriate drug use. Look for the following images in your search to find the right pharmacy for you: The Human Resources Benefits Team is always here to answer your questions. For some categories, health plans may limit the coverage of drugs to FDA-approved uses and require a prior authorization for off-label indications. Drug list for medications that qualify for the Smart90 program. Utilization of this logic allows plans to manage the benefit without requiring unnecessary member or prescriber disruption. Tips to keep in mind Go to to locate an in-network pharmacy. Fax: (833) 774-9246.
Easy & Cost Effective. This information can be requested by contacting the Customer Service Department. Connect with your Trustmark sales executive or client manager to learn more. A pharmacist would then evaluate the documentation to determine whether use of the prescribed drug for the indication provided is justifiable.
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