Prospective and Real Time
Benefiting both acute and chronically injured workers, AWPRx’s Clinical Management program proactively evaluates a medication's appropriateness and cost effectiveness at point of service.
AWPRx’s Protocol Guide rules work with common pharmacy adjudication Drug Utilization Review (DUR) edits to evaluate each prescription for inappropriate use associated with therapy duplications, premature refills, and availability of a generic equivalent to ensure the medication is appropriate for the injury and compliant with the workers’ compensation-specific formulary. Protocol parameters are an established set of rules/criteria defining how, when, and if medications are processed online. Parameters include, but are not limited to: Claimant level approvals/restrictions (Physician/Medication), Jurisdictional rule sets (generic mandates, fee schedules, etc.), Medication Price Cap, Temp Fill, and appropriate formulary.
Our Drug Utilization Review and Intervention Program that are performed by experienced PharmD professionals significantly impact the quality of care for injured workers.
Targeted monthly reporting identifies high risk candidates. Our Pharmacist provides an initial detailed and consolidated report of all potential drug related problems and recommendations. Our DUR and Intervention specialist then works with the claims handler on authorization. Once approved, we will provide the prescribing physician with a Clinical Intervention Letter and recommendations for future clinical care of the injured worker.
Medications included on the AWPRx Formulary, have been reviewed by the Pharmacy & Therapeutics (P&T) Committee, and have been found to be appropriate for inclusion on the basis of safety, efficacy, approved indications, ease of use, potential for adverse effects, and cost effectiveness. The P&T Committee consists of physicians, pharmacists, and clinicians representing a broad range of clinical practice and expertise internal and external to AWPRx, and meets quarterly to review and update the AWPRx Formularies.