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Acclaim
Prescription Benefit
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The Prescription Drug Benefit
helps control costs and improve care through the careful monitoring of the
prescription drugs utilized.
By tracking and reviewing the
drugs prescribed, the Prescription Benefit can identify the medications that
are prescribed, length of prescription therapy and the final outcome of
therapy which can be conveyed back to physicians and employee benefit
managers.
This information helps reveal
drug therapy problems or drug interactions, excessive use of high-cost
mediations, and provides medical information for total disease state
management.
Frequently Asked Questions
| 1. |
What if employees use a
pharmacy that is not in the network?
Pharmacies can be added to the
network at anytime. If there are specific pharmacies or new
geographical areas that need pharmacy coverage, contracts can be
extended to those pharmacies.
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| 2. |
How are pharmacy claims
processed?
Pharmacy claims are processed on-line
at the time a prescription is filled in the network pharmacies.
Most retail pharmacies utilize computerized prescription systems which
allow for transmission of member and prescription information to
various claims processing systems across the nation. The
employer group number and unique identification number route the
electronic information from the pharmacy to the correct claims
processing system.
Acclaim Prescription Benefit
Management utilized ComCoTec®, a national pharmacy claims processor,
for claims adjudication. Acclaim in on-line with the ComCoTec®
system which allows Acclaim to design and program individual employer
group benefit plans and access claim information at any time to assist
pharmacies or members with any on-line problems.
Once the pharmacy information is
transmitted to ComCoTec®, it edits against the programmed benefit
plan and returns electronic information to the pharmacy regarding
co-pay, eligibility and any other pertinent benefit parameters.
The process occurs in less than a
minute. This has become the standard in pharmacy claims
processing.
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| 3. |
What are the options for
co-payments?
The co-payment structure is
determined by the employer benefit manager:
 Optional deductibles
Percentages or flat rate co-payments
Multi-tiered co-payments for:
Generic/brand
Formulary/non-formulary
Preferred drugs
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| 4. |
What is formulary
management?
Once the employer group determines
benefit exclusions, any other covered services and therapeutic
categories can come under formulary management programs at any desired
level. Formulary management is a function of a Pharmacy and
Therapeutic Committee which reviews covered drug categories and makes
clinical decisions to promote the most effective and cost efficient
drugs within a class.
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| 5. |
Who can an employee call?
Acclaim provides customer service for
the prescription benefit services. Acclaim can answer questions
concerning eligibility, co-pays, deductibles, drug coverage, prior
approval, pharmacy network and reimbursement. |
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