Discuss reimbursement & UM review criteria you could potentially utilize
1. What kind of risk contracting, if any, would you enter into with providers for the use of the new drug in enrolled population? Discuss reimbursement & UM review criteria you could potentially utilize, as well as strategies for risk sharing and cost-shifting (a payment function). (500 words)
2. Describe how you will roll out the new patient education program related to prescription drug abuse to plan members through participating pharmacies (who expect to get paid for the service) with relevant clinical details (a clinical function). (150 words)
Promot will be giving
Requirements: 65o words single spaces
here is the prompt/ Instruction ;
Try to comprehend the nature and the scope of opioid addiction problem in America and recognize why prescription drug overdose is the leading cause of accidental deaths in the country. Then, read the scenario narrated below and respond to objectives, questions and challenges listed.
You are the Director, Formulary Operations, for ACME Pharmacy Solutions. Recently you have been reading reports about how Oxycontin abuse, the #1 most abused prescription opioid drug today, has become a leading cause of many accidental deaths in the community. You have learned through your pharmacy network liaisons that pharmacists are really concerned about the number of ODs they have been seeing in their practice everyday and are wondering if a Medication Therapy Management program might help. They are curious to know if the health plan you are representing would be interested in supporting it, but are unsure how to go about setting one up, if your PBM is supportive as well. They are seeking your help in establishing one for their pharmacy and want to know what\’s involved, structure- and process-wise.
Your goal is to promote the adoption MTM by your pharmacy partners to achieve community health care benefits, improve quality of pain management and/or opioid-related care, while also helping cut overall health care costs for the health plan. You also want to enlist the network pharmacists who wish to volunteer their expertise and time to increase patient and physician participation in the program and educate your patients about the new MTM program. The P&T Committee last week recommended that your formulary retain Oxycontin during the phase-out period (about 6 months to a year) to ensure its continued availability to your plan members, while switching and signing up more members to receive MOUD services (see the White-house document above). Media reports, drug dossier, available literature evidence, and the newly developed monograph etc. all indicate that the new drug is very effective and not likely to cause as much addiction; it\’s safer as well for the intended use.
Your objectives are twofold: 1) Help your pharmacy partners set up an effective MTM program to prevent opioid ODs & addiction, and 2) deliver effective overdose education program for the plan members who use these powerful yet dangerous drugs. Initial indications are that most pharmacists who are interested in helping you roll out the new program are expecting to get compensated well for their effort as well. So your job is to develop an action plan to curb the misuse of this drug among your plan members to avoid its dangerous consequences and increase pharmacist participation rates in the program, among other things.
Overall, your written report should cover the following aspects of MTM and patient education program.
And the following questions:
1. What kind of risk contracting, if any, would you enter into with providers for the use of the new drug in enrolled population? Discuss reimbursement & UM review criteria you could potentially utilize, as well as strategies for risk sharing and cost-shifting (a payment function). (500 words
2. Describe how you will roll out the new patient education program related to prescription drug abuse to plan members through participating pharmacies (who expect to get paid for the service) with relevant clinical details (a clinical function). (150 words )
Answer preview to Discuss reimbursement & UM review criteria you could potentially utilize
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