Pharmacy Management
What is Pharmacy Management?

Pharmacy Management: Because of skyrocketing costs, medications comprise a substantial portion of the healthcare dollars spent each year. Pharmacy Management is a critical strategy for health plan cost containment.

Data is retrieved by HealthComp through online access to the Pharmacy Benefit Manager’s database.

Pharmacy Management:

  • Identifies patients who would benefit from other HealthComp programs such as: Specialty Injectables, Wellness Management, Case Management, Care Advocate, or Mommies 2-B.
  • Review for medical necessity and authorization where applicable, upon request
  • Identifies trends in drug-use.
  • Identifies potential stop-loss claimants.
  • Identifies retail versus mail-order option.
  • Identifies those using brand-name drugs rather than available generics.
  • Identifies potential fraud.

Where applicable, Licensed Pharmacologists provide individual member reviews based on referrals from HealthComp's Wellness Management team. The Pharmacologists are available to make clinical determinations regarding appropriateness of medications prescribed, drug-to-drug interactions, available generic or more cost-effective medications, and possible fraud issues. As clinicians providing patient care, they also contact both members and their medical providers to discuss their findings or recommendations.

Various components of HealthComp’s Pharmacy Management program are included in programs such as: Specialty Injectables, Wellness Management, Case Management, Care Advocate, or Mommies 2-B, or it can be utilized separately.

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