| Drug Use & Management Group Benefits Unlimited utilizes Specific strategies to decrease health care costs by identifying pharmaceutical cost drivers and measuring the quality of care and the outcome. Group Benefits Unlimited uses an adjudication system with a network of pharmacies throughout Canada. With 99% of pharmacies represented, this is the largest pharmacy network in Canada. - 24 Hour Drug Claims Adjudication Service
- National Drug Card for real time on-line claims adjudication
Concurrent Drug Utilization Review
Patient history is reviewed in real time (electronic) and checked against:
- Immediate Eligibility Determination - is designed to ensure member/dependent eligibility, therapeutic choice and cost containment measures are strictly adhered to at the pharmacy level.
- Drug-to-age conflicts – will confirm dose and safety according to the indicated age of the patient
- Therapeutic duplication review – will identify a patient who is taking two medications with similar therapeutic effects. This ensures more cost-effective therapy and avoids adverse reactions.
- Too high too low dose review – verifies that the drug dose lies within recommended therapeutic guidelines
- Drug to Drug interactions – will analyze the current prescription with all other active prescriptions from all pharmacies for a patient, will detect any potentially dangerous or conflicting drug combinations and communicate this information to the pharmacist.
- Drug Allergies - Patients registering drug allergies with their pharmacist will receive allergy screening on each prescription filled.
Solutions - Generic Substitution
- Preferred Provider Network – Pharmacy chain level only
- Co-Payment
- Therapeutic Price Substitution
- Managed Cost Formulary & Clinical Management ( With special authorization) see below
- Exception Coverage – per group division / class
Deductibles / maximums - Coordination of Benefits Private and Provincial
- 90 day Maintenance Drug Supply
- Dispensing Fee Limitations
- Formulary Limitations
- Ingredient Cost Mark-up Limitations
- Exclusions
Managed Cost Formulary: a review of utilization patterns resulting in recommended strategies to eliminate unnecessary drug therapies and maximize benefit dollars. Clinicians examine new drugs coming to market in order to make recommendations as to whether these drugs should or should not be covered under your plan Special Authorization: A process designed to limit member access to high-cost drugs. Approval criteria are set in advance allowing for optimal use of benefit dollars. |
