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Scott Whitmore, R.Ph. Director of Clinical Services Milliman IntelliScript Brookfield, Wisconsin

Underwriting with Rx Histories: A Pharmacist’s Perspective. Texas Wide Underwriting Conference Houston, Texas March 19 th , 2012. Scott Whitmore, R.Ph. Director of Clinical Services Milliman IntelliScript Brookfield, Wisconsin. Agenda. Rx data sources Value of Rx histories

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Scott Whitmore, R.Ph. Director of Clinical Services Milliman IntelliScript Brookfield, Wisconsin

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  1. Underwriting with Rx Histories: A Pharmacist’s Perspective Texas Wide Underwriting Conference Houston, Texas March 19th, 2012 Scott Whitmore, R.Ph. Director of Clinical Services Milliman IntelliScript Brookfield, Wisconsin TWUC

  2. TWUC

  3. Agenda TWUC Rx data sources Value of Rx histories Limitations and challenges Rx rules

  4. Prescription drug use in the U.S. continues to increase. Center for Disease Control and Prevention. Health, United States, 2010; Table 94 TWUC • Spending • In 2008, consumers spent $234 billion on prescription drugs • Doubled from 1999 • Utilization • 48% of U.S. citizens used at least one prescription drug in the past month (2005-2008) up from 44% from 10 years prior • Cholesterol lowering drugs remain by far the most commonly used prescription drug (2007-2008)

  5. Americans increasingly use multiple medications. SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey TWUC

  6. Age, gender and race influence Rx use. SOURCE: CDC/NCHS, National Health & Nutrition Examination Survey (2007 – 2008) TWUC

  7. Rx history usage is increasing. Hank George Survey, November 2010 (99 companies reported) TWUC Life insurer survey results . . . • 68% reported using Rx in 2008 . . . 41% in 2007 • 71% increased use of Rx • 40% said Rx significantly contributed to the underwriting decision on more than 15% of cases

  8. Rx histories have become a standard screening tool. TWUC “At present nearly 80 percent of life carriers deploy pharmacy records in life underwriting….Virtually all others are at some stage of vetting this asset”. - Hank George, FALU, CLU, FML Making Progress in Life Underwriting. Resource. Feb 2012 ;12

  9. Top Reasons Reported for Using Rx Histories Hank George Survey, November 2010 Reduce anti-selection Improve mortality results Increase APS value by more selective ordering Reduce turnaround time Reduce APS use Reduce underwriting costs Facilitate automated underwriting Increasing use of Rx histories by competitors TWUC

  10. TWUC

  11. How does it work? Obtain the authorization Submit the query Review the results Data Source Data Source Data Source TWUC

  12. Rx data come from multiple sources. Health Plans Pharmacy Benefit Managers (PBM) administer Rx benefits PBM Applicant Employers Gov’t Retail Pharmacies TWUC

  13. ConfidentiTWUC al for SAMPLECOMPANY IntelliScript Rx history metrics . . . • Results usually returned in 3 - 5 seconds • Hit rate varies by line of business / insurer • Average Hit rate: 75% • Key driver: Socioeconomic status of applicant pool

  14. Sample Prescription History TWUC

  15. Rx histories bring extensive information . . . TWUC Indication Inherent risk (i.e. Red, Yellow Green) Condition severity Medication adherence Potential drug & lab interactions Black box warnings Prescriber type Number of pharmacies

  16. What’s the value of an Rx rules engine? TWUC • Efficient / Consistent interpretation • Route important cases to underwriters • More selective APS ordering • Improved mortality

  17. RxRules interprets prescription history data. • Interpretation • Conditions • Severity • Actions / Decisions RxRules Rx Data RxRules • Rule variables: • Indication / Therapeutic class • Drug combinations • Red / Yellow / Green • Fill timing • Fill counts • Dosage • Physician specialty • Gender / Age • Other rules TWUC

  18. Case Studies TWUC

  19. This is Frank, he's our LEAN champion streamlining paperless information flow TWUC

  20. Questions? TWUC

  21. Thank YouScott Whitmore, R.Ph.Director of Clinical ServicesMilliman IntelliScriptBrookfield, Wisconsin(608) 345-7159scott.whitmore@milliman.com TWUC

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