Clinical Decision Support
The formulary is the cornerstone of the drug benefit management process, however, many other service and management elements must be integrated into the formulary management/drug utilization management work flow. Covington Healthcare Associates typically interfaces with plans as an integral part of the Pharmacy and Therapeutics (P&T) Committee process, but can also work outside the P&T committee.
Clinical decision support services include, but are not limited to, the following:
- Formulary management/drug utilization management
- New drug reviews/monographs (traditional and specialty)
- Therapeutic class reviews/monographs (traditional and specialty)
- Recommendations for formulary inclusion/noninclusion and their tier placement
- Development (and updating) of prior authorization (PA) criteria
- Development (and updating) of step therapy criteria
- Development of exceptions criteria for nonformulary drugs
- Recommendations on quantity limits
- Data analytics/trend analysis
- Pharmacoeconomic modeling
- Development of guidance documents for prescribers
- Generic maximization through conversion programs
- Development of medication therapy management (MTM) protocols
- Policy development and refinement
- Quality initiatives (including adherence initiatives)
- Pharmacy case management
- Patient education
- Beneficiary health and wellness/health literacy.