Internet, mail-order Rx to serve 140,000 members

Integrated drug benefits improve efficiency

How do you manage a drug benefit program for 140,000 members without sacrificing efficiency or quality? For Scottsdale, AZ-based PCS Health Systems, the answer is an integrated program that incorporates internet access to ensure clear communication with the member employees, flexibility in prescription services, and quality assurance.

As part of a multi-year contract with the Fort Worth-based University of Texas System, PCS will utilize strategies that include mail service, clinical programs, and the use of the Internet for data transmission and plan member communication.

"One of the advantages of the Internet is that you can transmit eligibility information quickly and efficiently," explains PCS spokesman Blair Jackson. "We can quickly get new cards in the hands of our members, as information changes. Access is also available to pharmacies, so they can have accurate information."

"We send PCS our eligibility data sets, and we get real good turnaround time," explains Robert Molloy, director of the employee group insurance program for The University of Texas System (UT). "We put them on the server late in the evening, and by 8:30 the next day, they have loaded it into the system. That’s important when you have 15 different components (i.e., universities, medical schools) like we do."

In addition, the university has its own internal Web site, which includes information on how to use the plan, a copy of the prescription plan brochure, and a network pharmacy locator.

At UT, an integrated drug benefit program means both retail and mail service," explains Jackson. "The member can either get their prescription filled at a retail pharmacy or by using our mail-service pharmacy. Mail-service typically has a lower co-pay, and you can get a greater supply (i.e., 90 days vs 30) if you go by mail. And the order is delivered right to your home."

Mail-order works like this: The member sends a completed order form (provided on the PCS Web site) and a written prescription from their doctor. They can either indicate a credit card number or call in after they have received the prescription for the price and then mail a check. "These prescriptions are filled in PCS’ own facility in Fort Worth," explains Jackson. The facility, staffed by more than 40 pharmacists, serves PCS clients nationwide. Fully automated and computerized, it is capable of dispensing 30,000 prescriptions a day. "Right now, we’re at about 6,000," says Jackson.

UT has actually had an integrated program since 1992, says Molloy, but there are several things he likes about the PCS model. "There’s a little greater integration of the claims system and the edits — checking for conflicts of drug utilization on a real-time basis," he notes.

This is extremely valuable to the employer, the plan, and the employee, Molloy observes. "Most [beneficial] is the checking that can be done to make sure the member is not taking drugs in retail and mail-order pharmacies that might conflict. Older people, for example, don’t realize you may have to stop one drug when you start another; we have all that information in one database. Second, you have greater financial control."

UT will also participate in PCS’ "Performance Rx" therapeutic interchange program that encourages pharmacists, patients, and physicians to work together to help ensure clinically appropriate care. Under the program, retail pharmacists counsel patients and work with doctors to ensure the prescribing and dispensing of the most clinically appropriate and cost-effective brand-name generic drugs.

Which comes back to Molloy’s key concern: accuracy and appropriateness in the filling of prescriptions. "The edits are something we like because they help us make sure the right people are getting the right prescriptions," he concludes.

To "surf" the UT Web site, log on to www.utsystem.edu./egi/, then click on "Prescription Drug Program."

For more information about PCS and its services, log on to its corporate Web site: www.pcshs.com. Or, contact: Blair Jackson, PCS Health Systems, Inc., 9501 East Shea Blvd., Scottsdale, AZ 85260-6719. E-mail: blair.jack son@pcsmail.pcshs.com