PAYERS

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Apovia pharmacy operations...

complement its payer customer goals and objectives by providing quality pharmaceutical care services and collaborating on effective cost containment initiatives. 

The high-quality pharmacy services that Apovia operations can provide to our Managed Medicaid under-served population is unique from all other area pharmacies. The major differentiator is the Apovia arrangement of having a clinical pharmacist working hand-in-hand with all medical staff with patient’s doctor and nurses to optimize medication management.

Apovia has also initiated successful partnership initiatives that are mutually beneficial to local Federally Qualified Healthcare Centers (FQHCs) and local managed Medicaid health plans. These programs help lower drug costs to payers and financially support FQHCs ability to provide additional care to the under-served population. These data driven initiatives have been identified through extensive data analysis provided by Apovia.

Apovia further supports its payer customers by cooperating and complementing their prior authorization process which also supports our payer customer formulary compliance goals. Supporting our payer customer formulary goals helps to lower overall drug costs through drug rebate optimization. 

Other details on key Apovia payer support services regarding data analytics, case management, formulary compliance and pharmaceutical relationships are summarized as follows:

DATA ANALYTICS REPORTS

  • Drug Shipping Data

  • Utilization Management Reports

    • Prior Authorization related

    • Cost Saving Analysis Reports

  • Compliance Reports

  • Required pharmacy performance reports (i.e. patient medication adherence metrics, etc)

  • Ad hoc customized reports

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CASE MANAGEMENT SUPPORT

 

  • Compliance Reporting: Apovia pharmacy operations can provide medication compliance reports for case managers to help identify patients whose noncompliance may result in the increased need for hospitalization and other emergency medical care. These reports can help identify the least compliant patients and guide case managers to whom they need to monitor closely, depending on the control of the patient’s disease and the frequency of medical encounters (i.e. hospitalizations, specialist visits, etc.) involved in treating their medical condition. 

  • Coordination of Services: Apovia can work closely with health plan case managers in coordinating pharmacy services, especially if the patient has any acute medication needs, which may be the case for a hemophilia patient experiencing a bleeding episode. It is important to be responsive to patients who require immediate therapy in order to avoid a hospitalization and/or significant morbidity due to their medical condition. Apovia can also assist case managers if they become aware of a patient drug access issue. Apovia can tap into its patient support services for those patients that require financial assistance and / or other patient care support. 

FORMULARY PULL THROUGH CAPABILITIES FOR SPECIALTY MEDICINE

 

The 3 links to successful pull through:  

 

Apovia is fully aware that there are 3 critical links in the specialty medication formulary pull through chain include the Payer, Specialty Pharmacy, and the Pharmaceutical Manufacturer. Apovia leadership has extensive experience coordinating these 3 links for successful pull through services. Apovia proprietary processes help to facilitate successful formulary pull through programs. This expertise benefits Apovia payer customers by enabling them to optimize their drug manufacturer rebate arrangements.

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PHARMACEUTICAL MANUFACTURE RELATIONSHIP SUPPORT

 

Apovia pharmacy operations can assist payer clients with their business relationships with pharmaceutical companies in several ways.  Operating as a liaison on behalf of some of its payer clients, Apovia can assist in the evaluation of contract terms proposed by pharmaceutical manufacturers for medications that may gain preferred formulary coverage. This assistance may range from advising payers on the terms of agreements to managing the entire contracting process. Payer clients determine the level of involvement they would like for Apovia to have in managing agreements with pharmaceutical manufacturers. Apovia has the ability to provide the necessary reporting for executing any such rebate pharmaceutical manufacturer contracts.