Apply Evidence-Based Guidelines for Prescription Drugs
Balance Medication Efficacy and Cost For Optimal Patient Outcomes
MRIoA’s specialty drug reviews allow health plans, TPAs and PBMs to leverage specialists to ensure adherence to evidence-based guidelines for high-cost drugs. Our pharmacy utilization management services support treatment for medical conditions where a therapeutic interchange is available, to maintain the same efficacy for the patient while reducing cost.
Why overpay for prescription drugs? Leverage our specialists through peer-to-peer calls with prescribers to ensure medication is optimized for each patient.
MRIoA provides a timely independent clinical review of high-cost medications (typically drugs with a monthly cost of $5,000 or greater) to determine:
If the drug is medically appropriate
If appropriate, whether a lower cost generic or therapeutic alternative is available
If appropriate, a timeline to determine if the patient is deriving benefit and achieving therapeutic outcomes required for drug reauthorization
High-Cost Specialty Drug Review
Initial
Incorporate MRIoA’s High-Cost Specialty Drug Review for ~100 high-cost drugs into the initial PA process to determine when a lower cost therapeutic alternative is appropriate.
Appeal
Review to evaluate when a therapeutic alternative is appropriate; evaluate continued therapeutic benefit and establish checkpoints for further authorization.
Re-Auth
Review to evaluate when therapeutic alternative is appropriate; evaluate continued therapeutic benefit and establish checkpoints for further authorization.
Retrospective
Review is outside of the traditional UM program and can target high-cost medications where identified therapeutic alternatives exist; address potential medication stockpiling; evaluate continued therapeutic benefit and establish checkpoints for further authorization; provide guidance on difficult clinical cases.
Helping deliver the right care for member by providing therapeutic interchange options to providers delivered by MD specialist with an ROI tto PBMs and health plans
High-Cost Specialty Drug Review enables health plans, TPAs and PBMs to implement cost-saving solutions while increasing member satisfaction and ensuring members have access to the right medications at the right time.
The business impact of MRIoA’s High-Cost Specialty Drug Review:
QUALITY CARE
Ensure patients are receiving clinically appropriate specialty drugs
CLINICAL EXCELLENCE
Increase use of evidence- based treatment on high-cost drugs
LOWER COSTS
Control drug spend, especially for high-cost drug therapies
Why Delay?
Harness the power of an independent review to ensure evidence-based care and appropriate utilization of treatments.
