WellPoint NextRx: Delivering a Unique Approach to Pharmacy Benefits

The benefit management landscape grows increasingly complex each year. Health care has never been better and medical therapy and treatments are evolving rapidly, providing individuals with access to better care. Promising new medications are being developed to treat conditions for which there was once no medicinal recourse, while at the same time, employers are looking to manage the costs of overall medical benefits.

However, these encouraging developments come at a price, and the steadily rising cost of prescription drugs continues to be one of the most pressing challenges facing benefit managers. The urgency of controlling costs becomes even more apparent as the baby boomers enter their retirement years.

As a pharmacist myself, with more than 26 years in the industry, I understand the importance of making sure individuals receive the medications they need, when they need them, at a price they can afford. At WellPoint NextRx, it is our mission to enhance health by making sure people have access to quality, affordable pharmacy benefits. Understanding the challenges of the current environment we take a unique approach to pharmacy benefit management designed to help improve overall health.

We concentrate on people – from the individuals and clients we serve to the pharmacists and physicians with whom we coordinate to the professionals who make up our staff. NextRx provides pharmacy benefits to tens of millions of customers who fill prescriptions from more than 100,000 doctors at more than 60,000 retail pharmacies nationwide. To meet the needs of our customers, we count on the clinical expertise of our team, which comprises pharmacists, nurses and personal care coordinators.

We focus on our distinctive process. At NextRx, we put pharmacy at the center of health care to connect the right patient with the right therapy at the right time. Our health plan heritage and connection to WellPoint, Inc., one of the largest health benefits providers in the United States, allows us to integrate medical data with pharmacy data to help improve outcomes and guide individuals toward healthier lives. We understand the relationship between pharmacy costs and total medical costs, and we believe improvements begin with us. Using this data, NextRx can make more informed decisions about the impact of pharmacy selections to the pharmacy and the medical benefit. This informed decision making process is available for all our clients whether they are with one of our health plans or a stand alone pharmacy client. Ultimately, the objective of providing integrated care is to leverage the pharmacy benefit with the intent of reducing total cost of care and to help improve the quality of care for our clients.

Moreover, while NextRx follows a traditional process for the selection of drugs it places on its formulary through its Pharmacy & Therapeutics (P&T) Committee, NextRx does take a unique approach by employing a process that sets it apart from the competition using comparative effectiveness practices to support its formulary decisions. The NextRx P&T process always starts with a comprehensive review of all the clinical information available to determine whether the specific product is safe and effective. Going beyond the traditional literature-based review method, we incorporate an evidence-based medicine approach to the clinical review of drugs for formulary placement. NextRx places an increased emphasis on the results of effectiveness data, such as how effective the drug is among our member population, coupled with its ability to impact the disease state and the cost associated with it.

Our unique and innovative programs are designed to educate customers and improve access to quality, affordable medications. NextRx offers a complete suite of benefit designs to give employers choices that best meet the needs of their employees in a way that helps them manage their costs. We provide access to programs and information that help customers understand the importance of adhering to medication schedules and related therapies. These programs help some individuals to control chronic conditions and possibly avoid visits to the emergency room. For others, they can help reduce the onset of chronic conditions altogether. As a result, our customers tend to be healthier, allowing them to be more productive in their jobs and their lives.

Coupled with our innovative programs, NextRx offers the ease of a mail order service which not only helps customers who lead busy lives, but also helps manage their costs. Because many health plans offer a reduced number of copayments for using mail pharmacy, customers will typically receive a 90-day supply of medication for the cost of a 60-day supply. In addition, customers who utilize mail order service can often increase medication compliance, leading to improved outcomes. And, although customers save a trip to a retail pharmacy, they don’t compromise the ability to talk to a pharmacist. Our customers have access to pharmacists and pharmacy technicians who are available by phone for individual counseling and to answer questions regarding their medications.

At NextRx, we also seek to help promote affordability through a variety of generic management strategies. We allow customers to try generic versions of popular maintenance drugs to treat conditions such as high cholesterol for free for up to four months. Depending on their benefit design those who switch to generics can see savings of up to $30 per month on their medications.

To further address the needs of those individuals who suffer from chronic, debilitating diseases, WellPoint opened a state-of-the art specialty pharmacy in Indianapolis, which handles the most complex pharmaceuticals used by our customers. On staff is a skilled clinical team that understands the needs of individuals who are using these complex medications. More importantly, our team recognizes the need to provide enhanced education and support so that customers will get the most out of the medications to help them lead healthier lives.

Looking ahead, benefit managers face many challenges; chief among them is the ability to continue to provide access to care at an affordable price. While drug benefit management is just one piece of the equation, at NextRx, we believe it is critical to the solution and collectively we strive to help ensure our customers will rely on the cost savings, safety and convenience we provide.