Starting on January 27, 2016, Prime Therapeutics will be displaying “First Fill” high risk medication outliers for the health plans that they support (a listing of the health plan’s supported by Prime and displayed in EQuIPP are listed below). 

As a reminder, First Fill HRM outliers are provided by Prime Therapeutics and represent members who have filled one qualifying high risk medication (medication name is also listed) and represent a potential opportunity to prevent a second fill of the medication.  A “Standard Outlier” for the HRM measure, represents a patient that has already filled 2 qualifying high risk medications.  The medication name will be listed for only those medications/outliers that are designated as “First Fill.”  These outliers will be displayed as being “Provided By” Prime Therapeutics within the patient outliers table.

Prime Therapeutics is looking to community pharmacies to review these medications with patients and address the potential issues of HRMs with prescribers.  The goal is to allow for a proactive discussion to address new prescriptions for HRMs when presented at the pharmacy.  The list of First Fill HRM outliers will be updated on a weekly basis, which makes it increasingly important to regularly track patient outliers to help ensure appropriate use. 

What can pharmacists do?

By clicking on the “Outliers” button pharmacists can view the names of their patients that have filled the HRM and are members of a Prime Therapeutics supported health plan.  Pharmacy personnel can then take the following actions:

• Review the patient’s profile to determine if the HRM is medically necessary

  • If not medically necessary, the pharmacists should contact the prescriber to discontinue and notify the patient

• If the therapy is medically necessary, the pharmacists should determine if a there is a safer alternative available.

  • EQuIPP subscribers can access a list of high-risk medications and appropriate alternatives at http://www.pharmacyquality.com/Documents/PLHRMChart.pdf 

  • If an alternative is appropriate the pharmacists should contact the prescriber to secure the new prescription and notify the patient.

     

    Health Plans supported by Prime Therapeutics and displaying First Fill HRM Outlier Opportunities:

     

• Arkansas BCBS

• BCBS Alabama

• BCBS Minnesota

• BCBS North Carolina

• BCBS South Carolina

• Capital Health Plan (Florida)

• Florida Blue

• Horizon BCBS (New Jersey)

• Health Care Services Corporation (HCSC)

  • BCBS Oklahoma

  • BCBS Montana

  • BCBS Illinois

  • BCBS Texas

  • BCBS New Mexico