Star Rx Solutions Ashley W. Ellis, Pharm.D., BCACP, CDE Chief - - PowerPoint PPT Presentation

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 Diabetes Treatment Cholesterol Adherence

CMS Medicare Part D STAR Ratings

Hypertension Adherence Diabetes Adherence

How Star Ratings Impact PDPs

• High Performers

– Receive higher percentage of rebates per star up to 5 – Receive bonuses per member – May enroll beneficiaries prior to the open enrollment window

• Low Performers

– If maintained for 3 or more years, receive cuts to drug rebates per star – Are not eligible for bonuses – May not open enrollment early – 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
• ptimal 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