scott whitmore, r.ph. director of clinical services milliman intelliscript brookfield, wisconsin
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Underwriting with Rx Histories: A Pharmacist’s Perspective. Texas Wide Underwriting Conference Houston, Texas March 19 th , 2012. Scott Whitmore, R.Ph. Director of Clinical Services Milliman IntelliScript Brookfield, Wisconsin. Agenda. Rx data sources Value of Rx histories - PowerPoint PPT PresentationTRANSCRIPT
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Scott Whitmore, R.Ph.Director of Clinical Services
Milliman IntelliScriptBrookfield, Wisconsin
TWUC
Underwriting with Rx Histories:A Pharmacist’s Perspective
Texas Wide Underwriting ConferenceHouston, TexasMarch 19th, 2012
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Agenda
Rx data sources
Value of Rx histories
Limitations and challenges
Rx rules
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Prescription drug use in the U.S. continues to increase.
Spending In 2008, consumers spent $234 billion on prescription drugs Doubled from 1999
Utilization 48% of U.S. citizens used at least one prescription drug in the
past month (2005-2008) up from 44% from 10 years prior Cholesterol lowering drugs remain by far the most commonly
used prescription drug (2007-2008)
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Center for Disease Control and Prevention. Health, United States, 2010; Table 94
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Americans increasingly use multiple medications.
SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey
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Age, gender and race influence Rx use.
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SOURCE: CDC/NCHS, National Health & Nutrition Examination Survey (2007 – 2008)
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Rx history usage is increasing.
Life insurer survey results . . .
68% reported using Rx in 2008 . . . 41% in 2007
71% increased use of Rx
40% said Rx significantly contributed to the underwriting decision on more than 15% of cases
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Hank George Survey, November 2010 (99 companies reported)
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Rx histories have become a standard screening tool.
“At present nearly 80 percent of life carriers deploy pharmacy records in life underwriting….Virtually all others are at some stage of vetting this asset”.
- Hank George, FALU, CLU, FML
Making Progress in Life Underwriting. Resource. Feb 2012 ;12
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Top Reasons Reported for Using Rx Histories
1. Reduce anti-selection
2. Improve mortality results
3. Increase APS value by more selective ordering
4. Reduce turnaround time
5. Reduce APS use
6. Reduce underwriting costs
7. Facilitate automated underwriting
8. Increasing use of Rx histories by competitors
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Hank George Survey, November 2010
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How does it work?
1. Obtain the authorization
2. Submit the query
3. Review the results
Data Source
Data Source
Data Source
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Rx data come from multiple sources.
PBM
Retail Pharmacies
Pharmacy Benefit Managers (PBM) administer Rx benefits
Employers
Gov’t
Applicant
Health Plans
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IntelliScript Rx history metrics . . .
Results usually returned in 3 - 5 seconds
Hit rate varies by line of business / insurer
Average Hit rate: 75%
Key driver: Socioeconomic status of applicant pool
ConfidentiTWUCal for SAMPLECOMPANY
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Sample Prescription History
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Rx histories bring extensive information . . .
1) Indication2) Inherent risk (i.e. Red, Yellow Green)3) Condition severity4) Medication adherence5) Potential drug & lab interactions6) Black box warnings 7) Prescriber type8) Number of pharmacies
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What’s the value of an Rx rules engine?
Efficient / Consistent interpretation
Route important cases to underwriters
More selective APS ordering
Improved mortality
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RxRules interprets prescription history data.
Interpretation•Conditions•Severity•Actions / Decisions
Rx Data
Rule variables: Indication / Therapeutic class Drug combinations Red / Yellow / Green Fill timing Fill counts Dosage Physician specialty Gender / Age Other rules
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RxRules
RxRules
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Case Studies
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This is Frank, he's our LEAN champion streamlining paperless information flow
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Questions?
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Thank You
Scott Whitmore, R.Ph.Director of Clinical Services
Milliman IntelliScriptBrookfield, Wisconsin
(608) [email protected]
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