340B Poly-Pharmacy Member
Case Management Program

   In this program, approved by the Commonwealth of Pennsylvania (and compliant with 340B regulations), a Medicaid HMO identifies its “poly-pharmacy” members and delegates the case management of them to a Covered Entity. The Covered Entity, which has an existing 340B contracted pharmacy relationship with CCN, sub-delegates part of its case management responsibilities for these members to CCN (under a separate contract). Through mail, telephone and outreach techniques, CCN case managers (on behalf of the Covered Entity) conduct voluntary in-person health risk and medication assessments with each identified member, provide “spot referrals,” and generate recommended care plans to be reviewed and approved by both the Covered Entity and the Medicaid HMO. Once a care plan is approved, individual case management assignments are delegated back to the Covered Entity (by the Medicaid HMO), and then sub-delegated to CCN for activation, ongoing follow up and reporting.

   In addition to receiving ongoing case management services, each poly-pharmacy member is offered the option of transferring his/her prescriptions to the Covered Entity’s 340B contracted pharmacy( Coordinated Care Network Pharmacy), which provides free home delivery, refill reminders and other services. Because the Covered Entity is able to obtain medications at 340B cost, it is able to pass significant discounts to the Medicaid HMO. In this program, enrolled poly-pharmacy members receive case management, clinical pharmacy, home delivery and refill reminder services at no cost. The Medicaid HMO receives the clinical benefit of case management (which will likely reduce its inpatient spend), and deep discounts on its drug purchases (with the added benefit of pharmacotherapeutic and drug utilization review). The Covered Entity is able to generate new revenue streams, one for case management, the other for pharmacy services, and CCN receives dispensing fees for its contracted services. Presently, CCN and its partnered Covered Entity have an agreement with a Medicaid HMO to case manage 2,000 new poly-pharmacy members per month.