Point-of-Sale Intervention Program (POS)

LifeWise has a prescription for good medicine. That's why we've established the Pharmacy Point-of-Sale (POS) Intervention Program to improve the quality of pharmaceutical care for our members.

What is the Pharmacy Point-of-Sale (POS) Program?
The Pharmacy POS Program works together with your physician and pharmacist to make sure you are receiving the right medication therapy. The goals of this program are to:

• Improve the quality of your drug therapies
• Promote appropriate use of medications and
• Ensure the appropriate length of drug therapy

When a specific prescribed drug exceeds the recommended dosage, duration of therapy or number of refills, your pharmacist is alerted by a computer message and a point of sale intervention is triggered. Your pharmacist is then directed to call our Pharmacy Services Center.

What drugs are included?
We currently manage the following medications through the Pharmacy POS program:

• Migraine headache therapy drugs:

  Amerge®, Imitrex®, Maxalt®, Zomig®, Migranal® and Stadol®

• Drugs for Ulcers and other acid-related disorders:

  Prilosec®, Protonix®, Aciphex® and Prevacid®
  Cimetidine, Ranitidine, Axid® and Pepcid®

  (Note: Zomig, Aciphex, Prevacid, Axid and Pepcid are Tier 3.)

How do I benefit from the POS Intervention Program?
Maintaining good health and using your medications correctly is important to us. That's why we are working with your physician and pharmacist to make sure you are not taking too much medication or using your medication longer than necessary. The Pharmacy POS Program allows us to improve care by promoting appropriate medication use and facilitating follow-up care with physicians.

You win by:

• Getting the right medication,
• At the right dose, and
• For the right length of time.

You and your physician still make the decisions about your care and treatment and in some instances, this program will encourage you to seek follow-up care with your physician.

How does the program work?
Through a computer message, your pharmacist is alerted when a specific prescription exceeds the recommended dosage or length of therapy. The alert message asks the pharmacist to call the Pharmacy Services Center to obtain a one-time exception for a 30-day supply of medication. Once your pharmacist calls our Pharmacy Services Center, your prescription can be filled so you can continue your medication without interruption.

Later, it may be necessary for your physician to fax supporting documentation to our Pharmacy Services Center so we can authorize continued use of the medication. This cross-check is done to give you peace of mind that you are getting the right medication at the right dose and for the right length of time.

Why these particular drugs?
The drugs in the Pharmacy POS program have been chosen because in the past members have either overused them or used them incorrectly. This is not in the best interest of your health.

For example some members were taking certain migraine headache drugs on a daily basis. According to the manufacturers of the drugs and medical practice guidelines, daily use of these drugs is not recommended. In fact, daily use of these drugs often leads to rebound headaches. When this happens, the number of days on which the patient has headaches may dramatically increase.

The Pharmacy POS Program helps these members seek follow-up care with their physician. When it is needed their medications can be revised in accordance with recommended medical guidelines. Members with frequent headaches (more than 4 migraines per month) may benefit from being prescribed preventive medication(s) by their physician. These drugs sometimes decrease the frequency and severity of their migraine headaches. The goal is to help each patient find the migraine headache treatment regimen that works best for that individual.

What is my physician's role in the program?
Your physician is very involved in your care. He or she understands your health history and your current medical condition. If a pharmacy POS intervention is triggered, your physician needs to fill out a simple form and fax it to the Pharmacy Services Center.

Physicians can reach the Pharmacy Services Center Monday through Friday, 8am - 5pm

• Phone:   1-888-261-1756
• Fax:     1-888-260-9836.

Step-by-Step Process
Here's how the Pharmacy POS Program works, Step by Step:

1. A prescription is submitted by your pharmacy and our computer system checks the prescription drug therapy to see if it exceeds recommended guidelines.
2. If it meets the guidelines, your prescription is filled without interruption.
3. If it does not meet the guidelines, your pharmacist is alerted to call our Pharmacy Services Center.

• A few days later you'll receive a letter in the mail and fax forms from us. You need to mail or give the fax form to your physician or have your physician call our Pharmacy Services Center.
• If your physician wants you to continue on the medication therapy, he or she needs to fax the form(s) to our Pharmacy Services Center. We will review the information within one to two business days and a letter will be sent to you confirming the decision.
• Your prescription can be refilled at the pharmacy on the same day an approval decision is made.