Star Rx Solutions Ashley W. Ellis, Pharm.D., BCACP, CDE Chief Clinical Officer ashley.ellis@star ‐ rx.com
Objectives • Discuss Medicare Part D Star Ratings and how they impact PDP plans • Identify EQuIPP ratings and how they impact the relationship between independent community pharmacies and Medicare Part D Plans • Provide solutions through partnership that will help your pharmacy meet and exceed expectations of payers
Medicare Part D Star Ratings • Medicare drug plans rated on 4 areas: 1. Drug plan customer service 2. Member complaints, problems getting services, and improvement in the drug plan’s performance 3. Member experience with the drug plan 4. Patient safety and accuracy of drug pricing*
High Risk Medications Cholesterol Diabetes Adherence Treatment CMS Medicare Part D STAR Ratings Diabetes Hypertension Adherence Adherence
How Star Ratings Impact PDPs • High Performers • Low Performers – Receive higher – If maintained for 3 or percentage of rebates more years, receive cuts per star up to 5 to drug rebates per star – Receive bonuses per – Are not eligible for member bonuses – May enroll beneficiaries – May not open prior to the open enrollment early enrollment window – 1 Star Plans may not be allowed to enroll new beneficiaries
EQuIPP • Electronic Quality Improvement Platform for Plans & Pharmacies • Provides measures specifically for your community pharmacy: – Medication Safety • High risk meds in the elderly • Appropriate treatment of cholesterol in patients with diabetes • Drug ‐ drug interactions – Medication adherence • Oral diabetes medications • Cholesterol medications (statins) • Blood pressure (renin ‐ angiotensin system antagonists)
Community Pharmacy and EQuIPP • Community pharmacists can have an important impact on adherence through several verified strategies • MTM and Targeted Intervention (Stars and TIPS) – Must be offered to eligible beneficiaries – When not provided in the patient’s pharmacy, cases may be re ‐ routed to call centers or other pharmacies – When other pharmacies provide MTM, prescription business is almost always targeted and can cost pharmacies up approximately $3000 annually if transferred to the MTM provider pharmacy
How Star Rx helps your pharmacy 1) Identifying, providing and resolving your complete medication review (CMR) cases for Medicare Part D patients at your pharmacy 2) Identifying and resolving opportunities for Star Ratings interventions 3) Increasing traffic and script volume in your pharmacy based on increased recommendations for RX and OTC products as well as adherence interventions
Optional Services • Targeted Adherence Programs • Synchronization Program initiation and staff training • Prescriber outreach • Clinical service consultation and enhancement • EQuIPP improvement consulting
What we provide to you • Clinical expertise and expeditious resolution of all queued CMR and targeted encounters • In ‐ person and telephonic patient services • Availability for questions and consultation as needed Most importantly, we support what you already do! We keep your MTM patients at your pharmacy.
What we need from you • Agreed upon level of service • Your initial EQuIPP ratings summary • Executed contracts with MTM service providers (Outcomes, Mirixa and any wholesaler identified programs) adding me as an authorized user and administrator and exclusive provider of MTM • Support for patient appointments and contact information if needed • Routing of funds from services provided to Star Rx
Our Goal • Help patients become empowered to achieve optimal health • Enhance your patient loyalty and satisfaction • Enhance relationships between payers and your independent pharmacy • Optimize your EQuIPP ratings • To help maintain and expand patient pharmacy choice (to your independent pharmacy) based on excellence in patient care and satisfaction
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