Arkansas Municipal League Case Study
Background
The Arkansas Municipal League is a voluntary group of Arkansas cities and towns. Arkansas Municipal League’s mission is to serve its members in a variety of ways, through legislative advocacy, optional benefits programs, and training and educational opportunities. Risk management and loss control programs are key services provided by the League’s workers’ compensation division.
Situation
Arkansas Municipal League had been working with a Pharmacy Benefit Manager (PBM) who was not meeting the League’s commitment to its members to provide timely communication, customized solutions, and fair pricing for its services.
After vetting multiple vendors, Preferred Medical was selected as Arkansas Municipal League’s new PBM partner due to our detailed expertise in workers’ compensation pharmacy benefits management. Other important selection factors were our ability to implement a full, customized solution within a very quick timeframe, and our unique vision that defines what an integrity-based PBM partnership should entail.
Approach
Working together to customize the approach was critical. First, Arkansas Municipal League needed a partner who understands the complexities related to the state of Arkansas Workers’ Compensation Drug Formulary. Preferred Medical had direct experience executing complex formularies effectively, which was a significant benefit.
Another unique factor was that Arkansas Municipal League desired to leverage PharmDs from the College of Pharmacy at the University of Arkansas Medical Sciences (UAMS) to review all pharmacy authorization requests. This is very important as UAMS serves patients throughout the state through the Evidence-Based Prescription Drug Formulary and was instrumental in developing the Arkansas Formulary. Therefore, Preferred Medical was chosen as the best resource to make sure the formulary is followed, and the injured worker receives the medically necessary care and treatment for their unique situation. We worked directly with UAMS’s Pharmaceutical Sciences Department to customize the prior authorization process.
Outcome
One of the real differentiators of working with Preferred Medical is our ability to quickly build and implement a robust solution. In this case, we built and launched a custom PBM solution within 60 days – a process that can take 9-12 months with other companies.
Key features of the tailored solution built for Arkansas Municipal League include:
- Custom-built portal and prior authorization routing mechanism to allow efficient notification and access to the information needed, to render a clinically appropriate opinion on the non-formulary medication in question. This includes full access to the claim profile and treatment history to assist in the PharmD’s decision-making. The portal also serves as a key resource for the claims examiners’ real-time information on medication authorization decisions made by their partner PharmD team.
- Due to multiple parties involved in the process, along with the time-sensitive nature of drug authorization requests, we recognized the importance of an escalation cascade to be available and triggered at specific time spans if an authorization request ever sits idle, awaiting a response. Additionally, this tool assists with oversight support for claims supervisors and the management team.
- Timely and responsive communications remain at the forefront of Preferred Medical’s focus. Our team is committed to acknowledging any inquiry within 30 minutes of receipt and do our best to respond with an answer in 120 minutes or less.
- Custom reporting and analytics were created based on the unique needs of Arkansas Municipal League and UAMS.
The benefits of the PBM solution implemented, include:
- Significant cost savings with proven and quantifiable financial value.
- Improved customer service to the examiners, the League’s members, and the injured workers with proactive emails and calls.
- Workflows that supplement Arkansas Municipal League’s day-to-day processes, which help allow examiners and team members to focus on the most important aspects of their jobs.
- Dedicated account manager at Preferred Medical who is an advocate for and expert on the Arkansas Municipal League program.
- Creation of a wholistic approach to ensure that all stakeholders involved (examiners, League members, treating physicians and most importantly, the recovering employee) are being taken care of in the best manner possible.