WHI came to the rescue with a comprehensive strategy to manage the District’s $9 million pharmacy expenses. Consequently, Polk County School District’s pharmacy costs increased less than 1 percent last year.

    That amazing feat was accomplished with an innovative, comprehensive program of cost avoidance that actually improves care for the health plan’s 18,000 members. First, WHI took a "very assertive approach with our pharmacy program," implementing a three-tiered co-pay plan that encouraged plan members to use generic medications rather than more expensive brands when possible. With an aggressive campaign, generic utilization increased from 32 to 42 percent, saving the school district approximately $650,000 per year. Increased mail order utilization and pharmaceutical rebates saved additional dollars.

    To further cut costs and provide quality patient health, WHI recommended a Step Care Therapy program. It promotes the use of lower-cost medications as a first line of defense in treating certain conditions. Higher-cost medications are covered only when a patient’s profile indicates that the first-line agent is not recommended or has been unsuccessful.

    Although cost-avoidance is certainly a goal, so is improving plan members’ health, because, Henderson says, Polk County has "abnormally high levels of renal failure and many co-morbidity factors such as obesity and hypertension."

    To address this, WHI instituted a disease-management program for asthma, diabetes and other conditions. The program involves patient and physician intervention and pharmacist interaction to minimize emergency room and physician visits and improve overall health. WHI supplemented the District’s extensive wellness programs with specific programs targeting early diagnosis and disease prevention. "Consequently," Henderson says, "our members are taking a much more active, consumer-minded role regarding their health."

    WHI also monitors prescriptions concurrently, in real time, alerting pharmacists to potentially adverse drug reactions based on a patient’s condition or other drugs the patient is taking. It even checks for patient compliance and other therapeutic criteria.