Blues Plans Strategies for Mitigating Patients' Rx... -
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Published on: 1/1/2006
Last Visited: 1/28/2006
The physician members of the committee are "medical opinion leaders" from the community who represent large medical groups and are very vigilant about tracking drug risk signals from their practices, Premera Pharmacy Director Ed Wong, Pharm.D., tells The AIS Report.
The plan's outreach efforts focus primarily on pay-for-performance programs for physicians in large medical groups, mostly based on formulary compliance, "especially since we feel that our P&T process" , which follows the scientific literature and national practice guidelines , "is very sound," Wong says."So when we promote formulary compliance, we promote efficacy and safety," he maintains.The insurer also sends pharmacists to meet with medical groups to discuss prescribing patterns and make sure they are providing quality and safe care, he adds.
Yet when a high-profile problem comes up, the plan does take more aggressive action, Wong says.
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Another COX-2 drug, Pfizer's Celebrex, remains as a third-tier drug for Premera, with nonsteroidal anti-inflammatory drugs (NSAIDs) given preferred status, Wong says.The Minnesota Blues plan, guided by Prime Therapeutics' general formulary, takes a different approach and has Celebrex on its second tier so that patients who may truly need it, such as the elderly who are potential gastrointestinal bleeders, can easily obtain it, Heaton says.The plan even implements step edits in order to identify such patients, he notes.