Opioid Risk Management
The Serve You Rx Opioid Risk Management Program comprehensively addresses the misuse of prescription opioids and its consequences through monitoring, education, and intervention.
The program addresses the crisis of abuse and addiction, and the associated problem of rising costs, by reducing the likelihood of misuse through a multitude of proactive and retrospective approaches in four areas, including analysis, safeguards, education, and access to treatment modalities.
- Real-time analysis is performed on every submitted claim to detect duplicate prescriptions, early refills, excessive dosages, and unusual lengths of therapy.
- Opioid prescribing patterns, the dispensing patterns of pharmacies, and member utilization are retrospectively reviewed to identify those at risk.
- Formularies promote clinically appropriate drug use and generic utilization, achieving the best value from a clinical, cost, and member satisfaction perspective.
- Our pharmacists use a national prescription drug monitoring database to evaluate each prescription in the context of a member’s entire therapy, including prescriptions received from other pharmacies.
- Limits are enforced in alignment with CDC guidelines on the days’ supply, number of units, and refills within a given time period.
- Medical necessity of opioid use is confirmed before benefit coverage is approved, consistent with FDA recommendations on diagnosis and dose.
- Plan savings is achieved by requiring lower cost preferred medications before more costly alternatives are covered.
- Appropriate cost control and care management strategies are developed with guidance from the FDA to prevent fraud, waste, and abuse.
- Our website provides information about the proper disposal of unwanted medication.
- Our pharmacy ships a DisposeRx packet with each order containing an opioid.
- Clients are provided with useful, detailed reports about their membership’s opioid utilization.
- Educational content and resources, including presentations and articles, are available for a variety of audiences.
- The pharmacy benefits administered by Serve You Rx include best practice plan design inclusion.
- Access to naloxone as well as Medication-Assisted Treatment
- A non-pharmacologic digital therapeutic option called reSET-O
As a PBM and owner of mail pharmacy services, Serve You Rx recognizes that we have a position in the pharmaceutical supply chain, and given that position, we have a role in helping to combat the nation’s prescription opioid addiction crisis and to influence sustainable change in recovery advocacy and ending stigma associated with addictions. As such, we are proud to abide by Our Recovery-Friendly Workplace Credo.