Specialty Pharmacy Advocacy
Providing care management and cost containment solutions for specialty drugs
American Health’s Specialty Pharmacy Advocacy program is a timely, tailored program designed to support members and plans with
the high cost of specialty drugs. Medical management support is extended to members who are prescribed a specialty drug, but
don’t meet the criteria for Case Management. As a result, we are able to impact quality and savings in this complex and
evolving specialty market.
The program includes the option to select support for medical necessity review, member advocacy, steerage and claims review. Clients and plans can define which conditions will be addressed by the program and the business rules regarding when outreach should occur. Through collaboration with your PBM and Specialty Pharmacy, American Health can provide additional support and complement your existing programs.
Savings are achieved through medical necessity reviews, improved medication adherence rates, averted complications through member education, steerage to alternate care settings and review of claims and dosage.
Product Highlights:
- Support patients in achieving medication adherence
- Coordination with PBMs
- Protects the plan by providing medical necessity determinations for specialty drugs
- Physician review panel includes U.S. licensed Pharmacist
- Claims review identifies discrepancies in dosage
- Steerage to in-network providers and alternate care settings
- Identification source for members who are appropriate for Case Management
