Ks.luba.aug2010.final

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Ks.luba.aug2010.final

  1. 1. Your workers’ compensation pharmacy benefit manager About Us Clinical Aspects Information Technology
  2. 2. About Us <ul><li>KeyScripts is a national </li></ul><ul><li>Pharmacy Benefit Manager (PBM) </li></ul><ul><li>providing “boutique” services for... </li></ul><ul><ul><ul><li>Pharmaceuticals </li></ul></ul></ul><ul><ul><ul><li>DME </li></ul></ul></ul><ul><ul><ul><li>Translation </li></ul></ul></ul>
  3. 3. About Us <ul><li>We’re an interactive team of </li></ul><ul><li>Pharmacists </li></ul><ul><li>Nurses/Case Managers </li></ul><ul><li>Cost Containment Specialists </li></ul><ul><li>Information Managers </li></ul><ul><li>Legal Professionals </li></ul>
  4. 4. About Us KeyScripts is a workers’ compensation PBM serving insurance carriers and self-insured employers in a market dominated by healthcare PBMs.
  5. 5. BEST PRACTICES DEVELOPED THROUGH 30 years of workers’ compensation management and cost containment experience 50 years of clinical pharmacy experience About Us
  6. 6. Offers savings through OUR WORKERS’ COMPENSATION FORMULARY Workers’ compensation driven Excludes unrelated healthcare drugs Reduces abuse, duplication and fraud About Us
  7. 7. Offers savings through PRIOR AUTHORIZATION 1. FORMULARY-DRIVEN Drugs are tagged for authorization prior to fill, reducing costs associated with unrelated fills 2. ADJUSTER-DRIVEN Claimant-specific, as directed by the claims handler About Us
  8. 8. GENERIC SUBSTITUTION Where available, and when brands are not physician-mandated or requested by claimant Achieved through KeyScripts WC Formulary About Us
  9. 9. Optional FIRST FILL PROGRAM Temporary Prescription Benefit Cards distributed by employer when injury is reported Permanent cards then mailed to injured worker CARDS = COMPLIANCE = $$$ About Us
  10. 10. REVERSAL PROCEDURES Typically, invoices can be reversed up to 7 DAYS AFTER FILL About Us
  11. 11. REVERSAL PROCEDURES AFTER 7 DAYS Adjuster or repricer provides invoice to KeyScripts Pharmacy instructed to submit fills to KeyScripts Claimant reminded to take KeyScripts card to pharmacy About Us
  12. 12. Client had a 47% penetration rate when KeyScripts assumed program management on 10/1/08 About Us
  13. 13. SAMPLE STATE PENETRATION (No. of Pharmacies) LA: 1,061 MS: 808 AR: 731 TX: 4,182 OK: 875 NM: 298 Our Network PROVIDES NATIONWIDE COVERAGE About Us
  14. 14. Offers a national network of more than 60,000 PHARMACIES, including: CVS Pharmacy Walgreens Wal-Mart Rite Aid Target Kirby’s Family Pharmacy Healthcare Pharmacy The Pill Box Healthcare Pharmacy Kirby’s About Us
  15. 15. SUPERIOR MAIL ORDER SAVINGS (90-day supply) Brand: AWP – 9%* Generic AWP – 40%* * Off Average Wholesale Price (AWP), less $3.50 administration & dispensing fee About Us
  16. 16. SUPERIOR RETAIL SAVINGS Brand: AWP – 8%* Generic AWP – 35%* * Off Average Wholesale Price (AWP), less $3.50 administration & dispensing fee About Us
  17. 17. CLINICAL PHARMACY SUPPORT 50 years of professional clinical review experience that helps reduce claim costs 24/7/365 pharmacy help desk Speak directly to physicians to encourage use of generics and share information about new/less expensive drugs and substitutes Clinical Aspects
  18. 18. OUR CLINICAL PHARMACISTS Review claims to identify those that can benefit from more efficient/less expensive drug combination therapies Review claims for utilization and drug history to reduce incidents of drug interaction, duplication, abuse and fraud Clinical Aspects
  19. 19. <ul><li>DRUG UTILIZATION REVIEW </li></ul><ul><li>TRIGGERS </li></ul><ul><ul><li>Medication class (e.g., narcotics, other controlled substances) </li></ul></ul><ul><ul><li>Quantity & dosage </li></ul></ul><ul><ul><li>Supply </li></ul></ul><ul><ul><li>Quick fills </li></ul></ul><ul><ul><li>Opportunity for step-down therapy </li></ul></ul>Clinical Aspects
  20. 20. ENROLLMENT METHODS Daily data transfer of all new claims First Report of Injury from any direct reporting service, processed via Electronic Data Interchange (EDI) Telephone contact, fax or email from adjuster KeyLink – our web-based claims management portal Information Technology
  21. 21. CLOSURE, PERSONNEL CHANGE & FILE TRANSFER NOTIFICATION Daily data transfer Telephone contact, fax or email from adjuster KeyLink – our web-based claims management portal Information Technology
  22. 22. <ul><li>MANAGEMENT REPORTS </li></ul><ul><li>(Available monthly, quarterly, etc., through our IT Dept.) </li></ul><ul><ul><ul><li>High Dollar Drugs Report </li></ul></ul></ul><ul><ul><ul><li>Utilization of Controlled Substance Report </li></ul></ul></ul><ul><ul><ul><li>Top Narcotic Drugs by Utilization </li></ul></ul></ul><ul><ul><ul><li>Top Brand Drugs with Generic Equivalents by Utilization </li></ul></ul></ul><ul><ul><ul><li>Rejected Claims Resolution Report </li></ul></ul></ul>Information Technology
  23. 23. <ul><li>REPORTS AVAILABLE ON KEYLINK </li></ul><ul><ul><ul><ul><ul><li>Claim History Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>File Listing Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Monthly Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Top Drug Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Top Physician Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Top Pharmacy Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>High Dollar Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Top Drug Finance Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Top Physician Finance Report </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Top Pharmacy Finance Report </li></ul></ul></ul></ul></ul>Information Technology

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