Insights
The Sounding Board
Ideas and inspirations for the managed care industry
What is an MCO?
July 16, 2019
More often than not clients will ask the question: What is an MCO? Well isn’t that a loaded question? If we take it at face value, a Managed Care Organization (MCO) is an organization that manages care. Like Coventry, who manages all types of “care” injured workers seek to get on the road to recovery. However, usually the question has more to do with State Certified Managed Care Programs, commonly referred to as MCOs. From there it gets clear as mud. While the general category of state certified programs may be commonly referred to as MCOs, when you get into the state specifics you won’t find it to be that easy.
Investigating the Top Therapeutic Classes
July 8, 2019
First Script saw a decrease in opioid utilization across our retail and mail-order programs in 2018. In 2017, opioids made up 29.7% of total prescriptions, dropping to 26.9% in 2018, and representing a 2.8% decrease in utilization year over year.
Morphine Equivalent Dose (MED) Continues to Decline
July 1, 2019
In 2018 Coventry’s pharmacy benefit management solution, First Script®, saw a 7.8% decrease in average MED per prescription for its retail and mail-order channels. This was the largest decrease in the last 5 years across First Script’s retail and mail-order programs. In addition, there was a reduction in the percentage of opioid scripts with greater than or equal to 90 MED. To better understand why this is important let’s answer a few questions.
Top Therapeutic Classes by Age of Claim in 2018
June 25, 2019
In this video blog we discuss the types of medications utilized by ill or injured workers can vary depending on the age of the claim and differences in claim population. Understanding the most-utilized types of medications in younger vs. older claims can help guide decision-making and aid in identifying opportunities for intervention that can lead to better overall outcomes. Click the video below to learn more.
Will Naloxone Become Available for Purchase without a Prescription?
June 17, 2019
Today, there are two prescription products for use by laypersons. Namely, auto-injector (Evzio®) and intranasal (Narcan® Nasal Spray) naloxone. While they can be administered by someone outside of the healthcare profession, they are only obtainable with a prescription. The Food and Drug Administration (FDA) believes an over the counter (OTC) version may remove barriers for obtaining naloxone, particularly for people who are not under the care of a physician or who may be hesitant to admit to issues with opioid abuse.
How Long is a Filled Prescription Good For? Does the Medication Ever Go Bad?
June 10, 2019
The expiration date indicates the time period the prescription drug can be expected to meet the claims of the Pharmacopeial monograph (information sheet provided with a medication), that it conforms to the recommended storage conditions. These dates are usually found on the manufacturer’s container and may be included on the prescription bottle label, depending on various state requirements.
Defining Formularies & Step Therapy Medications
June 3, 2019
HealthCare.gov defines a formulary as, a list of prescription drugs covered by a prescription drug plan offering prescription drug benefits. Typically, a “prior authorization” for coverage is needed when a medication is not listed on the formulary or requires step therapy. Management of the formulary is often maintained by a pharmacy benefit manager (PBM), such as First Script. Meaning, when a medication is not on a formulary, First Script would start the prior authorization process to get approval for payment of the medication.
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