For Providers Current e-news April 2011 Current e-news Pharmacy Benefit Manager Express Scripts Plays an Important Role in Patient Safety Pharmacy Benefit Manager Express Scripts Plays an Important Role in Patient Safety
Express Scripts is the pharmacy benefit manager for Community Health Plan of Washington (the Plan). Based in St. Louis, Express Scripts is a Fortune 100 company that employs more than 14,000 people.
The Plan contracts with Express Scripts primarily for:
- Processing and payment of prescription drug claims.
- Management of the pharmacy network.
- Reviewing initial coverage determinations such as prior authorization requests.
Concurrent DUR
One way Express Scripts plays an integral role in patient safety is by reviewing all prescriptions electronically at the point of dispensing as part of the Concurrent Drug Utilization Review (DUR) program. Concurrent DUR is designed to enhance patient safety by identifying drug interactions that could negatively impact patient care and potentially result in an adverse reaction. Specifically, the program is designed to detect drug-age, drug-disease, drug-drug, drug-gender, and drug-pregnancy interactions, as well as high-dose drugs, ingredient duplication, and therapeutic duplication.
Most retail pharmacy systems are designed to detect drug interactions for prescriptions filled at that pharmacy or within a chain of pharmacies. Express Scripts' Concurrent DUR program detects drug interactions regardless of where the prescription is filled and sends an electronic alert message to the pharmacy at the point of dispensing. The key to the success of the program is having all the member's prescriptions, even very low-cost prescriptions, processed through Community Health Plan.
Express Scripts Contact Numbers for Providers
| Contact for | Phone |
|---|---|
| Prior Authorization--State Programs members | 1-888-256-6132 |
| Prior Authorization--Medicare members | 1-800-417-8164 |
| Pharmacy Help Desk (for assistance processing claims) | 1-800-824-08981 |
| Provider Relations (pharmacies who want to be added to the Plan network or receive status on payment/billing) | 1-877-776-8735 |
Important Pharmacy Links—State Programs
Find answers to these frequently asked pharmacy questions:
- Does Community Health Plan use a preferred drug list (formulary)?
- How often does Community Health Plan change the formulary?
- What if my drug is removed from the formulary?
- What should I do if I need a nonformulary drug?
- What should I do if I need prior authorization for a drug?
- What should I do to ask for a drug excluded by my medical plan?
- What is the difference between brand name and generic drugs?
- Does Community Health Plan prefer generic drugs?
- How many days supply of a drug can I get at one time?
- Do I have a copayment for prescriptions?
- Where do I fill my prescriptions?
- What other pharmacy services does my health program offer?
- What antiviral agents are covered by Community Health Plan?
Drugs that Require Prior Authorization
Drugs that Require Step Therapy
Did you know that...?
- The FDA is asking manufacturers of prescription acetaminophen combination products to limit the maximum amount of acetaminophen in these products to 325 mg.
- QVAR (beclomethasone) is FDA-approved for the treatment of asthma in patients 5 years of age or older and is the least expensive of the inhaled corticosteroids.
- Morphine may accumulate in patients with renal insufficiency/failure; therefore, methadone may be preferred in this population.