Specialty Therapy Management Program

Patient Notification and Enrollment

To ensure a smooth and seamless transition for the member, a proactive written and verbal communication occurs prior to Ascend SpecialtyRx providing service. The patients using specialty medications will receive a letter and a call informing them of the new program.

Prescribers will be provided with a patient-specific letter identifying the medication impacted, explaining the program and contact information for ordering the medication prior to the start date for the program.

Therapy Plan and Prescription Order Review

To ensure optimal outcomes from the therapy, Enrollment or Prior Authorization forms received with a prescription order are reviewed for completeness and accuracy, and adherence to evidence-based criteria, by a pharmacist.

Individualized Patient Care Plan & Patient Education

To ensure compliance and optimal outcomes, patients are contacted to review the physician-provided therapy plan and identify specific medication administration and therapy information educational gaps.  A patient-centric plan is developed, respecting the patient’s lifestyle and establishing expected outcomes of the therapy.

When enrolling the patient, the patient will be referred to a clinician for administration teaching and medication side effect discussions.  Once the clinician has completed these discussions, educational material is provided to the patient to help them manage their therapy.  

Criteria Review “Criteria No Pass No Ship”

To minimize off-label and unnecessary drug use, the prescription is evaluated against plan-approved, patient-centric, evidence-based criteria.  If the available information does not satisfy the criteria, then the plan is notified prior to shipping.

Dose Optimization

To prevent waste and lower costs, clinical information, including weight and various laboratory data, is used to optimize the dose and package size.

Pick, Pack, Ship & Track

To ensure patient safety and prevent damaged or lost orders, the approved order is then transferred to the dispensing area for picking, approval by a pharmacist, packaging in insulated, specialized packages, shipping through an overnight carrier and tracking the patient receipt of each package.

Specialty Therapy Management

To ensure optimal outcomes, a follow-up patient call schedule determined by the plan-approved criteria is established. Our Patient Care Coordinator will proactively contact the patient and evaluate compliance, adherence, side effects and educational gaps. Physicians will be contacted by the clinician if the issue merits.

Refill Management

To ensure proper utilization and prevent waste our Patient Care Coordinator will evaluate any required issue resolution and approve the refill and scheduled for delivery. 

Member/Provider Surveys

To ensure excellent customer service patient and physician surveys will be conducted at certain pre-determined intervals in therapy or at the completion of therapy patient to determine satisfaction with the services provided by Ascend SpecialtyRx.

Outcomes Reporting

To better understand the clinical interventions, cost, utilization, and impact of the Specialty Medication Therapy Management, client specific quarterly reports will be provided.