With ongoing medication shortages and astronomical costs for specialty drugs, nearly all members can benefit from medication savings. Furthermore, managing costs helps payers keep reimbursement rates steady for their partners. TOG has identified several tools that can help with cost-saving efforts.

Leverage proof-of-delivery for medication transport

Proof-of-delivery is just one tool payers can use to enhance security for members receiving medications in the mail, which undoubtedly improves member satisfaction. This offers peace of mind for pharmacies, prescribing providers, health plans, and patients alike.

Proof-of-delivery includes features such as tracking, analytics, and insights to help predict medication delays. This helps payers remain proactive in addressing member needs and allows them to communicate to resolve concerns efficiently.

These measures go far beyond managing costs. Experts predict provider networks will see an increase in claim audits from government funding organizations like CMS. Since most pharmaceutical audits occur more than five years after the medication has been delivered, staying organized is key.

How else can payers balance pharmaceutical costs?

  1. Stay in continual contact with pharmacies and providers to keep abreast of medication shortages, delays, and other distribution issues impacting their care. This will help payers implement targeted solutions early on.
  2. Collaborate with your provider network to develop workflows that aid in the early identification and resolution of distribution changes. Educate providers that standard U.S. carriers rarely offer enough details for medication-related proof-of-delivery, so providers should have their own procedures in place.
  3. Locate at-risk packages using real-time data whenever possible. This offers the highest level of accuracy, helps with preventive measures, and avoids any added burden on the provider network.
  4. Establish policies related to the organization and retention of proof-of-delivery data. Government organizations require providers to store this documentation for 7 to 10 years in a secure location. Ensure your provider network can easily access this data in the event of an audit.
  5. Facilitate the transition from paper documentation to digital solutions for any organizations in need of it. Cloud-based options offer more security and convenience, but facilities should account for additional administrative responsibilities that can arise.