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Background of Intervention
A 38-year old female sustained a burn injury less than three months ago. A retrospective clinical audit performed by a clinical pharmacist identified that two potentially unrelated medications (i.e., insulin), used for the treatment of diabetes mellitus, were authorized ongoing by a claims professional. These medications were authorized despite use of one of Progressive Medical’s Medication Plans which would not have allowed these medications to be processed at the local pharmacy.
Intervention
The clinical pharmacist notified the claims professional that two medications used for diabetes were authorized under the burn claim. In corresponding with the claims professional, it was determined that the medications should no longer be authorized and the file had actually closed. Subsequently, the claims professional requested the claimant’s retail drug card and pharmacy services terminated.
Results and Savings
Based on the current cost of medications used within the three month period, retrospective clinical review performed by our clinical pharmacist saved the client a minimum of $2,300 per year. Because the Medication Plan allowed for short-acting narcotics (used for acute pain), if the card remained open, this claimant could have potentially continued to fill unrelated medications under this claim.
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