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Sanovia PBM Webinar Series:
How to Manage Specialty Pharmacy Through Automated Clinical Review

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With a 19.5% increase in Specialty Drug Spend from 2008 to 2009 (2009 E.S.I. Drug Spend Report), payers are challenged with how to control specialty drug costs without compromising clinical quality. Prior authorization is an effective tool to manage this problem, but for many payers the specialty pharmacy prior authorization process is costly, resource-intensive and clinically inconsistent. The solution to this challenge is clear-a web-based prior authorization process that automatically applies best-practice clinical criteria with real-time integration of medical claims data.  This approach transforms the high cost and clinical inconsistency of manual reviews into an efficient, effective workflow that reduces administrative costs while improving overall clinical quality.  The net result:  specialty drug cost can be better controlled by ensuring that only medically appropriate requests are approved.

In this session, you will learn:
  • How your clinical policy can be applied consistently to specialty pharmacy prior authorization requests?
  • How to utilize integrated member benefits and formulary within the clinical review process.
  • What are interventions and where should they be used in the specialty pharmacy approval process?
  • The role of best-practice clinical criteria within a prior authorization process.
  • What is 'Intelligent branching logic' and why is it important to Specialty Pharmaceuticals?
  • What is Inter-rater Reliability (IRR) and why is it critical to your prior authorization process?
  • How to create a business case framework for clinically automating your current process?

 

Date:                                  Thursday, July 29th 2010 
Time:                                       2:00 PM - 3:00 PM EDT      

After registering you will receive a confirmation email containing information about joining the Webinar.
 
Our Speakers

 

Cheryl Allen, R.Ph.

Senior Director, Pharmacy Services

With 18 years of pharmacy experience including retail, health plan consulting and vendor implementation, Cheryl Allen keeps Sanovia's implementation teams and clients on the leading edge of pharmacy excellence.  Prior to joining Sanovia in 2005, Cheryl led pain management and oncology teams with a nationally known Specialty Pharmacy as well as serving as an independent consultant to a large Managed Medicaid plan.   As a licensed Pharmacist,  Cheryl specializes in managing Sanovia's URAC-accredited call center as well as training Sanovia's implementation teams on the latest industry updates in formulary, clinical interventions, and best practice workflow for the prior authorization process.

Matthew Plack, MPA;

Director for Strategic Alliances

As Sanovia's Director for Strategic Alliances, Matt engages pharmacy management solution vendors to deliver best-of-breed clinical automation and cost containment solutions to Sanovia's payer and PBM clients.  With 14 years of direct healthcare experience,  Matt has worked in product management and marketing with health IT leaders  including McKesson Health Solutions and Siemens Medical Solutions, as well as in sales and account management with MEDecision.  Matt's experience in working with payers and providers affords him a unique perspective on how software solutions can deliver a high quality clinical workflow that also is cost-effective.  Matt holds an M.P.A. from Penn State University and a B.A. from Bloomsburg University.