Selected Clinical/Trend Programs Clause Samples

Selected Clinical/Trend Programs. ESI offers a comprehensive list of trend, safety, care and disease management programs, a limited number of which are identified below, and which may change or be discontinued from time to time. ESI also offers savings guarantees under certain conditions. Information concerning such programs, guarantees and fees, if applicable, is available from the ESI Account Team. ♦ Retrospective DUR ♦ Retrospective DUR – Seniors $0.03/Rx $0.02/Rx ♦ Drug Quantity Management * $0.02 PMPM ♦ Prior Authorization – Clinical Supplemental List * $0.03 PMPM ♦ Prior Authorization – Other Clinical Overrides (e.g. non-standard prior authorization medications, medical exceptions) $20/request $25/physician review ♦ Step Therapy – Individual modules and packages available Over 25 modules available. The most utilized include: ACE inhibitors and angiotensin-2 receptor blockers (ARBs), non- steroidal anti-inflammatory drugs (NSAIDS) and ▇▇▇-2s, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), HMG – enhanced, calcium channel blockers, leukotriene pathway inhibitors, topical immunomodulators, other antidepressants. ♦ Formulary Rapid Response ♦ $0 Generic Copay Pricing varies by module $0.01 PMPM $1.25/member mailing or $1,000 for member identification and authorization ♦ RxPredict$ $0.05 PMPM for six months each time the report is run (e.g. 100,000 members * $0.05 PMPM * 6 months). A subsequent charge will occur with the second report. There is a minimum charge of $3,000. ♦ Care Management (Level 2) $0.01/claim – Asthma $0.01/claim – Cardiovascular Disease $0.02/claim – CHF $0.02/claim – Depression $0.01/claim – Diabetes $0.03/claim – GI Disease $0.02/claim – Hypertension $0.02/claim – Migraine * List of drugs subject to change at the discretion of Express Scripts.