Post on 28-Aug-2018
Excellence in Pharmacy Services . . . It’s Yours with MAXOR
®
Pharmacy Benefit Management Services
Each of MaxorPlus’ clients have a dedicated Account Management Team comprised of an Account Manager, Clinical Manager, and Senior Manager.
This team provides prescription drug benefit plan design, analysis and cost projection recommendations, and quarterly prescription drug benefit program reviews. Our high-touch model allows personalized service to all clients while saving hard dollars in claims cost and providing quality customer service.
Our proactive Account Management Team works with clients on a daily basis to ensure program effectiveness and resolve any questions. A MaxorPlus representative meets with clients annually, or more often as needed. Having a dedicated Account Manager allows clients to contact one person should any issues arise.
In addition, each individual will have special responsibilities as part of the Account Management Team for our clients. The Account Management Team is comprised of a group of individuals with a wide range of expertise in operations, pharmacy network management, clinical pharmacy, systems administration, eligibility management, customer service, finance, account management and marketing.
Dedicated & Accessible Account Management
Our dedicated Pharmacy Network Department works with network pharmacies prior to plan implementation by developing and distributing pharmacy network communications; responding to pharmacy network inquiries; and all other components related to MaxorPlus’ retail pharmacy network.
MaxorPlus’ Account Management Team has been designed to provide immediate access to key staff while maintaining centralized management
and accountability.
The following individuals will play a critical role during implementation
and ongoing activities:
• AccountManager
• ClinicalPharmacyManager
• DirectorofOperations
• DivisionController
• EligibilityCoordinator
• PharmacyNetworkCoordinator
• SeniorSystemsAdministrator/QualityControlCoordinator
Customized Member Communication MaterialsMaxorPlus provides all member materials, including:
• CustomizedIDcardproduction
• MemberPackets
– Welcome letter
– Member brochure
– Formulary
– Preferred Drug Alternative Listing
– Specialty pharmacy restriction list (if applicable)
– Mail order packet
MaxorPlus offers toll free telephone access to customer service representatives for use by benefits personnel, plan members, participating pharmacies and physicians. Our experienced representatives provide response to inquiries concerning:
• Planeligibility
• Planguidelines
• Deductible&maximumbenefitstatus
• Requiredco-paymentlevels
• Locationofparticipatingpharmacies
• Statusofidentificationcards
• Instructionsforcompletingapaperclaim
• Networkpharmacyquestions
• MaxorPluswebsiteassistance
• Pharmacyclaimassistance
• Priorauthorizations
Maxor Mail Order-specific questions:
• Medicationrefillsrequest
• Prescriptionorderstatus
• Medicationquestions
• Informationfornewmailordercustomers
• Medicationtransferinstructions
AllCustomerServiceRepresentativesparticipateinextensiveinitialand ongoing training. A pharmacist is available 24 hours a day, 7 days a week for urgent matters.
Experienced & Friendly Customer Service
The MaxorPlus Customer Service Department is comprised of a staff of well-trained Customer Service Representatives (CSRs), Team Leaders, Customer Service Management Staff, and the Director of Operations, who are collectively responsible for providing the highest level of customer service. The majority of CSRs are experienced retail pharmacy technicians or experienced Customer Service Representatives.
Online Member ServicesRegisteredonlinemembershaveaccesstomany
user-friendly tools, including:
• Personalprescriptionprofile
• Convenientonlinemailorderrefills
• Copaycalculator
• Preferredandgenericalternatives
• Druginformation
• Networkpharmacylocator
MaxorPlus offers its clients access to data reports through MaxSource and MaxView, both based on industry leading platforms.
DEMONSTRATION REPORTBRAND-GENERIC UTILIZATION
TRANSACTION DATE FROM: 06/01/2010 THROUGH: 06/30/2010
# Rxs Amt Paid ($)% Total Cost Avg Amt Avg Total Copay ($) Total Cost ($)Paid ($)/Rx
% Rxs Avg Member DaysCost ($)/RxPaid ($)/Rx
SINGLE SOURCE BRANDS
MULTI-SOURCE BRANDS WITH NO GENERICS AVAILABLE 118.96 12,167.8014736.18 82.77 5,318.80 17,486.606,8292.04% 1.93%
MULTI-SOURCE BRANDS WITH GENERICS AVAILABLE 217.00 23,415.1113543.56 173.45 5,880.01 29,295.127,3591.88% 3.23%
TOTAL FOR ALL BRANDS 288.45 615,203.562,51143.45 245.00 109,095.82 724,299.38132,46734.88% 79.75%
TOTAL FOR ALL GENERICS 39.24 138,310.044,6889.73 29.50 45,624.50 183,934.54174,29365.12% 20.25%
303.96 579,620.652,22943.92 260.04 97,897.01 677,517.66118,27930.96% 74.60%
GRAND TOTAL 126.16 753,513.607,19921.49 104.67 154,720.32 908,233.92306,760100.00% 100.00%
12-Month % Rxs Generic Usage
1 Report Package (1_report_package_charts)
7/19/2010 3:58:41 PM
Page 4 of 11
DEMONSTRATION REPORTTOP PHARMACY ANALYSIS
TRANSACTION DATE FROM: 06/01/2010 THROUGH: 06/30/2010
Pharmacy Category # Rxs U&C Amt ($) Copay ($) Amt Paid ($) Avg Rx ($)
Mail Order 781,289.902,166 74,303.17 440,584.96 203.41
Retail 425,504.244,994 76,630.84 228,348.90 45.72
Specialty 211,926.9039 3,786.31 84,579.74 2,168.71
TOTAL FOR ALL PHARMACY CATEGORIES
GRAND TOTAL
7,199 1,418,721.04 154,720.32 753,513.60
7,199 1,418,721.04 154,720.32 753,513.60
104.67
104.67
Pharmacy Categories # RxsJune's Top5 by # Rxs
Amt Paid ($)
MAXOR MAIL ORDER 2,166 440,584.96
WALGREEN CO. 1,752 72,829.20
CVS 763 40,734.60
WAL-MART CORPORATION 494 16,326.94
KROGER-HEADQUARTERS 449 18,688.96
Chain/Pharmacy Amt Paid ($)June's Top5 by Amt Paid
# Rxs
MAXOR MAIL ORDER 440,584.962,166
MAXOR SPECIALTY PHARMACY 84,579.7439
WALGREEN CO. 72,829.201,752
CVS 40,734.60763
KROGER-HEADQUARTERS 18,688.96449
1 Report Package (1_report_package_charts)
7/19/2010 3:58:17 PM
Page 3 of 11
MaxorPlus’ExecutiveSummaryReportPackagesaredistributedtoclientsmonthly and are available both electronically and in print. Each Executive SummaryReportincludes:
Cost Analysis
• Numberofmembers
• Numberofclaims
• Grosscost
• Membercopaysand deductibles
• Plancost(netcost)
• PlancostPMPM
• CopayPMPM
• UtilizationPMPM
• PlancostperRx
• CopayperRx
• Copay%ofgrosscost
• %genericusage
Pharmacy Network Analysis
• Pharmacypaymentsummary
Drug Utilization Analysis
• Brand-genericutilization
• Top20drugssortedby#Rxs
• Top20drugssortedbytotalcost
Recipient Analysis
• Ageaudit
Physician Analysis
• Top20physicianssorted by#Rxs
• Top20physicianssorted by total cost
Flexible & Accurate Reporting
Retiree Drug Subsidy AssistanceMaxorPlus has a team which assists with the RetireeDrugSubsidyprogramforourclients.OurteamfacilitatestheRDSapplication
process, including:
• Coordinatingtheactuarialattestation and supporting all application components
• Uploadingmonthlyretireecosts
• Helpingcoordinateeligibilityfileswith theclientandCMS
• Providingfinalreportsfor reconciliation purposes
Integrated Pharmacy ReportingMaxor’s reporting system is integrated with all claims data, including mail order, retail, and specialty pharmacy.
Timely and accurate reporting is a key component for clients to evaluate and participate in the management of their plan.
Clinical Pharmacy Initiatives• Formularydevelopmentandmanagement• Drugutilizationreview
(concurrent,retrospective,prospective)• Educationalprograms• MaxResultsclinicalprograms – Implementation of quantity limits – Clinicalpriorauthorization
administration – High claims cost monitoring – Narcotics monitoring – Step therapy programs – Adherence monitoring – Mail order interventions
– Auditing – Targeted/focused
interventions – Plan analysis – Genericincentive
programs – Specialty pharmacy
programs
Adaptable & Attentive Clinical Pharmacy Management
The MaxorPlus clinical department can fully administer the clinical services, or can assist in managing our clients’ clinical services, from prior authorizations to step therapy, quantity limits, and more. These programs are customized to meet each individual client’s needs. Most of the clinical programs are targeted to both the patient and the providers.
Our consultative approach by clinical pharmacists for pharmacy benefit plan design and coverage recommendations has proven to be a valuable tool for our clients when designing their prescription drug programs.
All of MaxorPlus’ clinical programs are monitored by our clinical staff, in addition to our extensive reporting tool, to ensure cost containment to our clients and safety for our members.
Clinical Pharmacy Initiatives• Formularydevelopmentandmanagement• Drugutilizationreview
(concurrent,retrospective,prospective)• Educationalprograms• MaxResultsclinicalprograms – Implementation of quantity limits – Clinicalpriorauthorization
administration – High claims cost monitoring – Narcotics monitoring – Step therapy programs – Adherence monitoring – Mail order interventions
Adaptable & Attentive Clinical Pharmacy Management
The MaxorPlus Preferred Drug Formulary is developed by physicians from various areas of expertise and pharmacists who strive to ensure the most cost-effective and medically appropriate drugs available are included.
Formulary drug selections are based upon each drug’s clinical efficacy, sideeffectprofile,pharmacokinetics,dosingregimens,drug/foodinteractions,contraindications,toxicity&safety,monitoringrequirements,uniqueness/similaritiestootheragents,utilizationtrends,outcomestudiesand cost-effectiveness.
MaxorPlus prides itself in providing a balanced formulary that offers ourmemberscosteffectiveoptionsinalltherapeuticclasses.Bydoingso, member satisfaction levels with their benefits remain high while our clients are able to save money on their prescription drug program. We will proactively work to keep members and their doctors informed of all of their therapeutic alternatives.
One of our goals as a Pharmacy Benefit Manager is to effectively manage our clients’ prescription drug costs while continuously improving the quality of pharmaceutical care for members, through the implementation of clinical pharmacy initiatives.
Maxor Mail Order Pharmacy• Prompt,accuratedispensing,includingbarcodechecking
• Convenientrefillsavailableonline,usingvoiceactivated
telephone system, fax, or mail
• Deliveryof90daymedicationstoyourhome,office,or
alternate address
– Free standard shipping
– No additional customer charges for refrigerated medications
delivered via overnight or second day delivery
• Clinicaldruginterventionsatthepharmacydispensinglevel
• Deliverytrackingavailableonline
Retail Pharmacy NetworkMaxorPlus’ comprehensive retail pharmacy network provides pharmacy locations nationwide to plan members. Our clients and members can access the MaxorPlus website to determine which network pharmacies are available for them by searching for any ofthefollowing:pharmacyname,city,stateand/orzipcode,oracombination of any of these.
MaxorPlus provides a comprehensive solution for mail order pharmacy, retail network pharmacies, and specialty pharmacy.
Completely Integrated Comprehensive Network
Specialty Pharmacy ServicesMaxor Specialty Pharmacy applies strategies that manage the high cost and complexity of specialty medications available through medical and pharmacy benefits via our sophisticated data analysis, ongoing communication and reporting tools.
Refillremindersandeducationareprovidedtopatientsbyourclinical staff, and convenient online refills are easily accessible to patients. Maxor provides convenient medication delivery direct to the patient, physician office or an alternate site of choice. Medication shipments are coordinated, so they arrive when requested by the patient and physician.
Maxor has extensive experience with chronic disease states. Our goal in managing these conditions is to improve patient adherence and outcomes through proactive management and retrospective review. The list below is a sample of the chronic disease states treated by Maxor Specialty Pharmacy.
• Asthma
• Crohn’s
• CysticFibrosis
• Diabetes
• GaucherDisease
• GrowthHormone
• Hemophilia
• HepatitisC
• HIV/AIDS
• ImmuneDeficiency/IVIG
• Infertility
• MultipleSclerosis
• Oncology
• Osteoporosis
• PainManagement
• Psoriasis
• RheumatoidArthritis
• RSV
• Transplant
320S.PolkStreet
Amarillo,Texas79101
(806)324-5400•(800)658-6146
Fax:(806)324-5495
www.maxorplus.com
Since 1926, Maxor has met the challenges of an
evolving health care environment. From its beginnings
as a single pharmacy, today Maxor is a nationwide
provider of pharmacy services, helping clients shape
their healthcare futures.
Located in Amarillo, Texas, MaxorPlus has provided
Pharmacy Benefi t Management (PBM) services since
1991, with fully integrated mail order pharmacy
services, specialty pharmacy services, clinical pharmacy
services, account management, customer service, retail
pharmacy network, and more, all in the same location.
®
Pharmacy Benefit Management Services