Caremark quarterly clawbackd

[ZakMeister]

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Being a new manager, I have been exposed to the quarterly reports from the PBMs and I just got the caremark one in the other day. Please help me understand and suggest how to go about these:-

1. Gap therapy for statins- how can we let the plans know that doctors don’t wanna just blindly prescribe statin? And if they are discontinued, are they getting accounted for in the metrics?

2. Also what does formulary compliance mean? Filling a drug that needs PA/ non formulary drug will penalize the pharmacy?

 

[Twentytwelve2]

I am a manager and I have never heard of any of these reports.

 

[ZakMeister]

I am a manager and I have never heard of any of these reports.

Not sure if you work for an indie or not. They tend to go to the owners directly.

 

[CynicalIntern]

Being a new manager, I have been exposed to the quarterly reports from the PBMs and I just got the caremark one in the other day. Please help me understand and suggest how to go about these:-

1. Gap therapy for statins- how can we let the plans know that doctors don’t wanna just blindly prescribe statin? And if they are discontinued, are they getting accounted for in the metrics?

2. Also what does formulary compliance mean? Filling a drug that needs PA/ non formulary drug will penalize the pharmacy?

1) They don't care. It's like when you work for Walgreens and you have to justify to your bosses that "there are no more people in this city who need a flu shot" - If you're not sneaking up and sticking Unchained against his will, your excuses are invalid.

2) Yes. Which is the most ridiculous thing that PBMs penalize us for, in all honesty. I'm not the one writing it, and I'm not the one approving coverage for it. So I'm supposed to call the doctor and say "hey I know you wrote this, and think it's the most clinically appropriate therapy for the patient. Let me tell you why you should change it: Because the insurance wants you too, and is telling me that they'll pay me less if you don't. Two things that the doctors office MOST CERTAINLY care about.