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Preferred Drug List Development, Implementation, and Maintenance

Provider Synergies has extensive experience and success in developing Preferred Drug Lists (PDLs) for both commercial and government clients that serve the dual needs of delivering significant savings and maintaining broad member access to quality pharmaceuticals.

The Provider Synergies Clinical/Account Management team is comprised of advanced degree clinical pharmacists. Most of the clinicians on this team participate in clinical drug reviews and evaluation as well as account management. This underscores the emphasis that Provider Synergies places on the clinical aspects of its programs.

Provider Synergies' process for PDL management remains consistent over time. As part of our ongoing strategy to provide a value-oriented approach to pharmaceutical care, Provider Synergies' clinical staff continuously monitors the status of drugs in development (the drug pipeline), FDA activities related to approval of new drugs and new indications, as well as other labeling changes.

The process used by Provider Synergies in developing its PDL recommendations combines clinical and financial information in a competitive contracting process. These recommendations also consider an analysis of disruption and savings models based on the expected impact of alternative PDL recommendations.

Provider Synergies routinely uses a fast-track approach in order to maximize savings for its clients. For most of the clients implemented to date, Provider Synergies has reviewed more than 60 Therapeutic Drug Classes in the first six to nine months of each program. It is expected that 10 to 12 Therapeutic Drug Classes will be reviewed at each Drug Review meeting. Each meeting agenda will be tailored to the clinical complexity of the classes being reviewed and the number of decisions to be made.

Pharmacy and Therapeutics (P&T) Committees

In addition to maintaining a highly qualified Provider Synergies P&T Committee, Provider Synergies provides procedural advice and clinical/financial analysis support to the P&T and Prior Authorization Committees of clients who maintain their own. Through our Medical Director and P&T medical specialists, we have access to clinical institutions, medical education centers, centers of excellence and "Thought Leaders".

Provider Synergies routinely utilizes proprietary Therapeutic Drug Class Reviews that are prepared by its clinical staff. This group of experienced clinicians performs thorough literature searches to ensure that the most current, published, peer-reviewed clinical trials and information are included. In these reviews, all of the medications within a Therapeutic Drug Class are compared based on relative safety and efficacy, side effects, dosing, indications and prescribing trends. Regional or state demographic or disease data is also considered.

The clinical staff of Provider Synergies continually reviews the medical literature for newly published, peer-reviewed clinical drug trials that may further our understanding of the clinical safety and efficacy of specific drugs within the various Therapeutic Drug Classes. Using this information, the clinical staff maintains up-to-date versions of Therapeutic Drug Class monographs that summarize the medical literature pertinent to comparing and contrasting the various drugs within each class. This thorough review process ensures that the monographs present a balanced picture of the relative clinical strengths and weaknesses of each agent within the class.

Therapeutic Class Selection

Provider Synergies' financial analysts provide ongoing analysis of the state's utilization data to determine the most appropriate strategies for maximizing rebate opportunities.

Each Therapeutic Drug Class on the PDL will be reviewed at least annually. This ensures that the PDL reflects the most current medical knowledge, state utilization and other market indicators. Among other factors, Provider Synergies prioritizes Therapeutic Drug Class reviews based on the significance of any newly approved drugs and/or indications. When possible, newly approved products are reviewed with the Therapeutic Drug Class to which they belong. This provides the opportunity to more accurately evaluate the relative value of the new product. When this is not practical, Provider Synergies will provide a single-drug review for evaluation. New strengths and dosage forms are handled as line extensions to current PDL agents where appropriate.

Implementation

Provider Synergies works with each client to develop and maintain a working PDL to meet the needs of the client, providers and members. Provider Synergies' implementations of these programs have proceeded smoothly and the PDLs have been well accepted by the provider communities.

Provider Synergies utilizes smaller project teams with a history of working relationships. This allows for the development of a cohesive team culture with a team comprised of individuals with experience in the specific project areas. Advantages to this approach include promotion of informal communications and minimization of organizational disjoints. The Primary Coordinator serves as the internal project leader and is responsible for communicating goals clearly, managing the team as a group, and setting high standards. The adequacy of staffing is monitored and reported on a continuous basis. A work plan is presented to each client for approval. Once approved, it provides a baseline against which the process of the project can be measured. Additionally, the plan forms the basis for communicating project objectives, assignments and progress to project team members.