Zynchros

In this Issue

• Musings by Bob Pinkerton
• Managing Multiple Formularies by David Smith
• New Customer Case Study: HealthSpring Leverages the Zynchros.com PQM Platform to Expand Pharmacy Benefits Offering to the Medicare Market
• Webcast August 26th: Accelerating Your e-Prescribing Initiatives
• Tips and Tricks: 2009 Part D Member Formulary..."All Rolled Up" by Chad Anderson
• Improving Formulary Compliance and Provider Communications, by Sheryl Lowenhar of ePocrates, Inc.

Musings

by Bob Pinkerton, COO, Zynchros

Bob is on vacation. His article will resume next month.

Managing Multiple Formularies

by David Smith, VP Product Management, Zynchros

Modern consumers demand more and more choices, and that’s no less true for prescription drug plans than for any other product.  Insurers have responded by providing choices in the level of coverage, for example “Silver” and “Gold” plans to complement the standard offering.  But there are many other ways to offer choice as well. Some plans now offer benefits targeted to particular market segments, for example seniors or young adults.  Another way to offer choice is by targeting specific diseases or conditions. A new innovation is to offer Value-Based Insurance Designs, where the goal is to promote prescription compliance by offering certain drugs at low or zero copay in order to prevent more serious (and expensive) health episodes later. For example, a VBID for asthma might offer inhaled corticosteroids at the lowest copay level (even though only brands are available) to promote regular use. (See this article for a good overview of VBID.)

On the downside, with choice comes complexity, especially for the insurer that has to create, maintain and administer multiple formularies.  Fortunately, there is a solution with Zynchros Commercial Plan Pro, our solution for managing and synchronizing multiple formularies using rules.  Effective tools rely on accurate data, and with the Medi-Span MDDB database built in to Zynchros.com, you can create multiple formularies targeted to different market segments easily, and keep them up-to-date and synchronized over time.  In this webcast I gave jointly with Tara Burkhart of Medi-Span, we showed how you can use Zynchros Commercial Plan Pro and Medi-Span data together to create several examples of multiple formularies.  Take a look if you haven’t already, and let me know what you think – I welcome your feedback!

David Smith
VP Product Management
david.smith@zynchros.com

New Customer Case Study: HealthSpring Leverages the Zynchros.com PQM Platform to Expand Pharmacy Benefits Offering to the Medicare Market

First, we want to thank our customers who have generously given their time to assist us in putting together these documents. We are eager to share them with you.

This month we are showcasing HealthSpring and their successful application of the Zynchros.com platform within their comprehensive Part D process. You can download the case study here.

Webcast August 26th: Accelerating Your e-Prescribing Initiatives

Register Now!

Ensure Complete and Accurate Formulary Data Delivery Throughout Your Electronic Prescribing Network
Electronic prescribing initiatives are receiving extra attention these days due to interest and support from government agencies, consumer and industry advocacy groups. Health plans and pharmacy benefit managers need to answer one important question to ensure the initial success and continuing growth of their e-Prescribing programs – How do we cost effectively deliver and update formulary information to prescribers, pharmacies and members?

Please join us for a discussion of how your organization can accelerate your e-Prescribing initiative while ensuring complete and accurate formulary data delivery throughout your electronic prescribing network.

Register Now!

Tips and Tricks: 2009 Part D Member Formulary..."All Rolled Up"

by Chad Anderson, Zynchros

Have you opened a 2009 Member Formulary export created by Zynchros and wondered why some drugs display the dosage form while others do not? Or why only certain listings display the drug strength? Well, we have your answer; it’s the Formulary “Roll Up” logic that is used to create the document.

Let’s take a look at a few examples of this:

As you can see below, there are two listings for Abilify: Abilify and Abilify Discmelt. This demonstrates that Zynchros is “rolling up” the drugs by name. Notice there is no specific information provided (Dosage Form, Strength, or Route of Admin) for either of these listings. To your members this means that you cover every available form and route of Abilify, at the same coverage level, that is listed on the current Formulary Reference File.

Now, looking below, we see some additional information added to the end of the drug name even though the tier and notes are all the same. This listing shows that we are only covering the listed tablet strengths along with the solutions. Because we explicitly removed a few different tablet strengths from our formulary, Zynchros has now provided more detail to your members.

In our final example we see even more lines of Abilify in our document. In this case there is a coverage difference between the two Abilify solutions. To the member this will signify that all available Abilify injections are covered at Tier 3 with a PA, every other available solution is covered at Tier 3, and only the listed tablet strengths are being covered.

I hope this has shed some light on the inner workings of the 2009 Member Formulary. If you have other questions look for the “Zynchros.com: Member Formulary 2009 FAQ” or download the “Zynchros.com User Guide” located on the Help page.

Improving Formulary Compliance and Provider Communications

by Sheryl Lowenhar of ePocrates, Inc.

Epocrates, Inc. develops clinical information and decision support tools that enable healthcare professionals to find answers more quickly and confidently at the point of care.  More than 500,000 healthcare professionals, including one in four U.S. physicians, use Epocrates’ innovative mobile and web-based products to help them reduce medical errors, improve patient care and increase productivity.  In a 2006 Brigham and Women’s study, 60% of Epocrates users reported avoiding three or more times adverse events in the previous four weeks¹.  The company’s trusted clinical content is developed by physicians and pharmacists and is continuously updated to keep users informed and up to date.

Epocrates subscribers have free access to the formularies for over 120 hospital and health plan clients and all Medicare Part D formularies.  Epocrates includes this up-to-date formulary information into their mobile and web-based clinical references, enabling easy access to integrated formulary and drug information at the point of care. Providers can verify formulary status and co-payment tiers, view alternative and generic substitutions, check quantity limits, and look up prior authorization requirements when making prescribing decisions.  By working with Epocrates, health plans can increase both their generic utilization and preferred brand prescribing rates while at the same time enabling your providers to save time and avoid pharmacy callbacks².

Epocrates offers formulary-hosting services to hospitals and public and private sector health plans.  These organizations work with Epocrates to:

• Encourage formulary compliance
• Strengthen provider relations
• Manage rising drug costs by promoting the utilization of lower cost medications
• Simplify formulary management
• Increase member satisfaction
• Lay a foundation for ePrescribing

Zynchros and Epocrates have been working together since February 2007.  The companies provide health plans a solution that streamlines the delivery of drug coverage information from health plans to providers.  Plans manage their formularies with Zynchros and publish them through Epocrates to its subscriber base of over 500,000 users.  The Zynchros Formulary Conversion Service is only available to Epocrates clients and was built as a bridge to convert formularies from the Zynchros formulary management database to the Epocrates formulary database. The service will:

• Ensure your formularies are complete and accurate
• Launch your Epocrates formularies more quickly
• Reduce man hours associated with reformatting formularies
• Ensure Medicare Part D formulary compliance

Contact your Zynchros representative to find our more about the Zynchros Formulary Conversion Service and how Epocrates can provide you with formulary distribution to your providers.

¹JAMIA, Volume 13, Number 6, Nov/Dec 2006
²Various third party studies using Epocrates and health plan client data

Did You Miss a Webcast? Want to Share Information with a Colleague?

You know us – online, on-demand, 24/7 – well, that means you can get the information you need when you want it.  Visit our website Resources page and download a webcast, whitepaper or data sheet.  You can also read past issues of Zyntrigues, inspect sample reports and request a demonstration.