The prevalent use of powerful, addictive narcotics in the healthcare system is a major driver of Rx costs. Prescription drug overuse increases claim costs, claim durations, and puts patients at risk of overdose and addiction.

The Benefits of Taking Action

Rising’s Physician Pharmacy Review program takes action on drug misuse and abuse, so you can:

  • Decrease the time and manpower needed to identify at-risk cases
  • Act early and proactively
  • Reduce addiction potential
  • Improve patient health outcomes and productivity
  • Increase return-to-work probabilities, for workers’ comp cases
  • Cut prescription costs

5 Steps to Early Intervention

Avoid unnecessary expense through early detection of questionable prescription usage behavior. Rising intervenes with five proven steps that reduce your claim costs.

Step 1: Rx Intelligence
Our award-winning Rx Intelligence pharmacy analytics flag your at-risk cases by tracking prescription activity, including:

  • Fill datesRx Analytics
  • Number of fills
  • Usage days
  • Average fill interval days
  • Dosage amounts
  • Urine drug screenings
  • Costs
  • Prescriptions from multiple providers
  • Escalation and weaning patterns

Step 2: Nurse Drug Evaluation
Rising nurses alert you to cases that may benefit from a Physician Pharmacy Review.

Step 3: Physician Pharmacy Review
Our pain management physician reviewer contacts the prescribing physician with recommendations (i.e. medication alternatives, frequency, dosage and/or a weaning program).

Step 4: Tracking

Rising’s Rx Intelligence technologies track the case to assess positive improvements.

Step 5: Telephonic Case Management (optional)
Rising’s telephonic case management can be used to ensure the physician reviewer’s recommendations are implemented.

5 Key Questions to Ask About Your Pharmacy Evaluation Program

  1. Does it provide a complete medical picture or is it limited to prescription fill information?
  2. Is it proactive and actionable? Does it identify questionable activity early in the claim?
  3. Are drug screens included in your dataset, and does your solution show if drug screens are being over or underused?
  4. Does it show the prescribing activity for all drugs, not just opioids, and identify escalation or weaning patterns?
  5. Can you easily see prescriptions from multiple providers?

Physician Pharmacy Review Services: