Opioid Risk Management

Analysis

• 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.

Safeguards

• 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.

Education

• 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.

Treatments

• 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