Department Of Publie Welfare - Pharmacy Carve Out / Consolidation

What is a Pharmacy Carve Out/Consolidation?

The Department of Public Welfare (DPW) take responsibility for processing all pharmacy claims and managing all pharmacy services for Medical Assistance (MA) consumers statewide.

  • The Seven Physical Health Managed Care Organizations (PH-MCOs) are responsible for managing all physical health services
  • Under the Pharmacy Carve Out, PH-MCO members receiving their pharmacy and specialty pharmacy drug services through the DPW pharmacy program.

Need to Implement Pharmacy Carve Out/Consolidation:

A Pharmacy Carve Out is good for following reasons,

 Pharmacy Carve Out - Facts :

Followings are some of the facts about DPW Pharmacy Carve  Out / Consolidation.,

  • Under the DPW pharmacy program, DPW collects federal Medicaid rebates and state supplemental rebates which are not available under managed care.
  • An external consultant to the DPW compared the PH-MCOs’ utilization management programs with the DPW pharmacy program and determined that the programs are of comparable value.
  • A single, state wide pharmacy program eases the burden of tracking multiple formularies and prior authorization requirements for prescribers and pharmacies.

Pharmacy Carve Out and MCOs:

  • The Department will make pharmacy claims data available to both the PH-MCOs and the Behavioral Health MCOs (BH-MCOs) to support and assist them in managing care.
  • Pharmacy data will be supplied on a weekly basis.
  • The proposed model is structured similar to commercial payers’ use of Pharmacy Benefit Managers (PBMs). Some of the PH MCOs already use this model.

Disclaimer: The Information & Data of this blog is taken from the Department of Public Welfare Document.

An external consultant to the DPW compared the PH-MCOs’ utilization management programs with the DPW pharmacy program and determined that the programs are of comparable value.
 Posted in Pharmacy Carve Out
  Tags department of public welfare pharmacy benefit management services company pharmacy carve out

Health Care Industry News and Millennium Administrators RX plans

Health Care Industry News:

Several new generic medications recently became available in the marketplace. As a part of the standard benefits and procedures, these new generic drug products are automatically added to the formulary, and the brand name versions move to the third tier.

Over 550 generic drugs are on the Formulary, maximizing the member's opportunities to utilize the lowest copay tier. A manufacturer's brand name version of a drug can cost more than four times the generic version in some cases.     

Millennium RX Carve Out:

Millennium Administrators, Inc. offers Stand-Alone Rx benefits for employer groups with 50 employees or more. Most of the stand alone RX plans are a self-funded model the employer only pays for “what they use”. Our wildly successful Pharmacy Carve-Out Plan lets companies get the best quality prescription medication – whether generic or brand named - for the absolute lowest price. Best of all, you can stay with your current health-care provider! Learn more about Millennium’s Pharmacy Carve-Out Plan.

Millennium Administrators RX plans:

Millennium Administrators RX plans, the specialty drugs continue to grow at a rapid pace! Specialty drug spending grew by 16.9% in 2005-significantly faster than the 5.4% average trend for drug spending as a whole. These drugs are used to treat a broad array of complex diseases, including

  • Rheumatoid Arthritis
  • Hemophilia
  • Cancer
  • Hepatitis C
  • Anemia
  • Cystic Fibrosis and
  • Growth Hormone Deficiency

These diseases accounts for an enormous cost to employers’ health spending. In order to control the spending trend in these categories, It would be recommended that you consider a pre-cert mechanism or a benefit cap on these types of medications. Call us today at  866-MHG-2489 to evaluate your present plan design!

 Posted in Rx Benefits
  Tags pbm company pbm service pharmacy carve out rx benefits rx plans

Self Funded Insurance Plans - Common Problem and a Solution

Common Problem: Insurance Carriers and administrators use the prescription drug portion of a medical benefits package as a major profit center, and often recommend that their clients should not "Pharmacy carve-out" or "un-bundle" the prescription drug benefits, ultimately at the client's expense.

A Solution from Millennium HealthCare Group: The Millennium Administrators Self-Funded Prescription Drug Plan. Millennium Healthcare Group's program offers mid-size companies (under 5,000 employees) the discounts that large companies enjoy, along with full-time consulting and customer service for clients and plan members.

Our solution saves money without reducing benefits: we match the existing plans to minimize member disruption and to allow for a true plan-to-plan financial and service-related comparison.

Other benefits that our clients enjoy:

  • Dedicated Client Account Managers
  • Dedicated Customer Service Teams for each group
  • Live, domestic Customer Service Center where a human answers the phone during regular business hours
  • Courteous and knowledgeable customer service staff
  • Pharmacy Carve Out, Pharmacy Management Service, health and wellness services for all
  • Customized plan materials and benefit summaries
  • 58,000 pharmacies nationwide, including all major chains
  • In-depth analysis of data with recommendations to fix flaws in the plan and put the control back in the group's hands.

Quick Facts:

  • Millennium Health Care Group is a leading provider of Pharmacy carve out, Pharmacy benefit management services (PBM services) company
  • Prescription drug benefits can be unbundled from the medical benefit.
  • Millennium Healthcare Group's goal is to provide an efficient and effective Rx plan.
  • Millennium Healthcare Group removes the revenue streams that Carriers build into their plan costs.
  • For groups under 5,000 employees, Millennium Healthcare Group can save approximately 10% to 35% on the cost of prescription drugs.

 

 Posted in Insurance
  Tags pharmacy benefit management services company pharmacy carve out selffunded insurance plans