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Real-time analysis is performed on all submitted claims to detect duplicates, refills too soon, and excessive dose or length of therapy.
Opioid prescribing patterns, dispensing patterns of pharmacies, and member utilization are retrospectively reviewed to identify at-risk members.
Our pharmacists use a national prescription drug monitoring database to evaluate each prescription in the context of a member’s entire therapy, including prescriptions they’ve received from other pharmacies.
Limits are enforced in alignment with CDC guidelines on the days’ supply, number of units, and refills of opioids that members can receive within a given time period.
Before benefit coverage is approved, the medical necessity of using opioids is confirmed to ensure they’re used in the most appropriate cases and dosages as recommended by the FDA.
Opioid costs are kept at bay by requiring members to try preferred drugs before more costly alternatives are covered.
Appropriate cost control and care management strategies are developed with guidance from the FDA to prevent fraud, waste, and abuse.
Our website provides detailed information on how members can dispose of their unwanted medication, and we ship DisposeRx with each order containing an opioid.
Clients are provided with useful, detailed reports on opioid usage within their membership, as well as progress on their participation with the program.
Educational content and resources, including presentations and articles, are available for clients to share with their members.