Optimize Plan Design with 4 Practical Use Cases for Therapeutic Alternatives

What if a prescribed medication has an ineffective response, intolerable side effects, onerous prior authorization requirements, or is just plain too expensive?

Pharmacy benefit managers (PBMs) and health plans have their hands full with plan design, formulary modeling, customer service through member portals, and the prior authorization process.

The overarching goal for pharmacy and therapeutics (P&T) committees at PBMs and health plans is to optimize plan design and maintain patient safety. But there are thousands of medications (and they’re always changing). Formulary design is no easy feat. The benefit plan can go out-of-date quickly.

This leads to frustrated members and providers when they hit medication roadblocks like high costs and unpleasant side effects. These four practical use cases for Surescripts Therapeutic Alternatives demonstrate how to help solve the problem.

Use Case #1: A Clinically Robust, Single Source of Truth

Ordinarily, the creation and maintenance of a “single source of truth” for therapeutic alternatives costs too much in terms of time and money.

Therapeutic Alternatives is that source of truth with a clinical catalog that contains a massive evidence-based collection of medically accepted, use-specific alternatives.

The catalog includes 200+ therapeutic categories and more than 30,000 alternative pairs.

Use Case #2: Expanded Breadth & Detail

New medications come to market all the time, and not all of them are a one-to-one match for older medications. Therapeutic Alternatives delivers more medications with more detailed clinical specificity:

• The 200+ therapeutic categories and 30,000+ alternative pairs go beyond simply grouping drugs by traditional drug classes or drug codes.
• Our catalog includes built-in logic for clinical factors such as dosage frequency and formulation variety, medically accepted indications (label and off label), treatment guidelines, and clinical differentiation.

Stay abreast of pharmaceutical developments for the formulary—and let Therapeutic Alternatives do the work of incorporating new products into therapeutic alternative drug lists that drive your downstream clinical programs.

Use Case #3: Stay Up to Date—Easily

Medications on the market change. Clinical guidelines change. Prices change.

It’s just about impossible to stay up to date, but not with our in-house clinical team, which is fully dedicated to maintaining the clinical catalog and keeping it up to date.

Our own experienced P&T committee reviews all enhancements, maintenance changes, and recommendations regarding new medications and alternatives. And rather than updates arriving once a year—the norm in the industry—we deploy updates every week.

Use Case #4: The Beauty of Standard Formatting & Delivery

Even after you’ve found a clinically robust catalog for therapeutic alternatives, the next chore of implementation and data integration can sometimes stymie even the most forward-looking PBMs and health plans.

To solve that problem, we deliver a universal catalog with standard formatting for import and usage, complete with representative National Drug Codes (NDCs) that map easily to compendia at your organization.

And deployment can be as rapid as three weeks.