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Facing increased pharmacy benefit expenses, Blain’s Farm and Fleet, a Midwestern employer group, desired to improve plan performance. Specifically it was interested in educating eligible members about the benefits available to them, promoting cost-effective…
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Putnam | Northern Westchester Health Benefits Consortium (PNW HBC) was the first municipal cooperative health plan in the state of New York to become certified by the Department of Insurance. They are dedicated to meeting — and exceeding — the standards…
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As part of their treatment plan for hypophosphatasia (HPP), a rare genetic disorder affecting bone and teeth development, one of our members required Strensiq, a medication designed to manage HPP. However, Strensiq’s annual treatment costs ranged from…
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RISE is a comprehensive Star Ratings Improvement program that focuses on positive outcomes for Medicare Part D (Part D) clinical measures, including: medication adherence for diabetes medications, medication adherence for hypertension, medication adherence…
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Patients with chronic diseases can face greater risks for medication-related challenges such as non-adherence. This can lead to poor health outcomes and higher plan costs. That’s why we developed an MTM program, offered through our Clinical Engagement…
Personalized Member Transitions: Creating a Smoother Benefit Transition
Navigating benefit transitions is no easy task. Our personalized member transition (PMT) program makes it smoother for both plan sponsors and members. Through our high-touch outreach to members, we eliminate gaps in care, minimize member disruption, improve…
Pharmacy and Practitioner Exclusions and How to Resolve Them
Prescribers and Pharmacies can be deemed ineligible for providing services to government programs like Medicare, Medicaid or even to payers who are participating in government programs. Being ineligible to provide those services is commonly referred to…
