The Edge

Putting ourselves in the shoes of plan members is not difficult, since CastiaRx employees are, after all, healthcare consumers who also use CastiaRx as our PBM. We understand how vital it is to anticipate and meet the needs of members at every step of the journey – without stress or complication – as part of our commitment to great service.

“Currently we are looking broadly at the entire member experience from top to bottom,” explains David Skomo. “We know there are opportunities to enhance our service levels.”  As SVP, PBM Operations, Dave leads all CastiaRx member-facing departments to drive better collaboration across our contact center, clinical and mail order operations. With 25+ years of PBM experience, Dave has a well-earned reputation for maximizing quality, satisfaction and efficiency. His team is driving improved operations through strategic investments in people, process, technology and training.

“Training is a key focus for us,” Dave explains. “In revamping our contact center employee training program, we now have a dedicated training position on the team – an experienced trainer to carry out an aggressive training program.” Dave points out that this level of expertise, combined with the award-winning curriculum of Diplomat University, builds an enthusiastic staff that is well-prepared to accurately respond to questions and guide members.

Strong leadership is vital and Cornell Beck joining our team in January as Associate VP and GM of Mail Order is an example of attracting the best talent to CastiaRx. “We assessed our team last year and saw the need to bring in the right type of leader,” says Dave. “With strength in the healthcare industry, process improvement and Lean Six Sigma methodologies, Cornell has an exceptional background that fits nicely with our mail order pharmacy.”

Technology paves the way for a more effective operation. Step into our mail order pharmacy in St. Louis and you will notice that our robot is always on the move, filling prescriptions with speed and precision. Humans are always necessary, but for routine tasks repeated countless times a day, the robot earns a special place on the team. In today’s busy, digital world, our mobile app is another standout, enabling an instant connection to member information, medication history, mail order, refills and soon to come – prescription package tracking.

“My leadership team closely monitors our daily performance and is committed to making real time adjustments to stay on top of member needs,” says Dave.

Subsys is a Fentanyl sublingual spray used to treat breakthrough cancer pain — approved only for cancer patients on round-the-clock opioids. When our Prior Authorization (PA) team received a request marked, “URGENT – Cancer Pain – Patient Almost out of Medication,” it was approved for a one-time, 30-day fill with chart notes requested. Eight days later, the same type of request was received again, but with an increased dose. Cost of the medication was more than $18,000 for eight days.

During their review, our PA team noted that the patient was taking NO pain medication for baseline pain control, resulting in poorly managed pain with a high-cost, addictive opioid drug. We also discovered that the patient had been cancer free for five years, and that the prescriber had received more than $1.75M from pharmaceutical manufacturers for promoting their products.

After follow-up with the client, the member was referred for urgent case management with a new pain specialist who got his pain under control and weaned him off the inappropriately prescribed Subsys. However, the prescriber continued to appeal the decision even after the patient advised he was going to another doctor. Eventually, the FBI seized the office records of the prescriber as part of an investigation into physician payments. Meanwhile, the patient was able to enjoy improved activity levels and quality of life on significantly less narcotic medications, with better pain control. This patient’s most recent pain medication was filled 10 months ago at a cost of $19 per month.

Behind the scenes, our CastiaRx Drug Information Team works diligently to help you avoid surprises – by giving you the latest news, updates and industry insights you need to manage your pharmacy benefits. With the launch of our new Clinical Corner, these materials are gathered in one convenient online location, categorized and easily accessed any time.

“Our goal is to share what clients need to know to stay up-to-date,” says Anna Bird, Clinical Drug Information Pharmacist. “Our team reviews industry news, assesses the relevance of topics for our clients and determines how to best communicate the details.” We know you are busy and this industry changes rapidly. Our role is to provide timely information that can impact your pharmacy plan and coverage decisions.

You can reference Clinical Corner at any time to find essential information, safety updates and important clinical news – along with an archive of past materials for ease of reference. “We’ll continue to convey timely information,” Anna says, “using email, Immediate Releases and other formats. But the Clinical Corner will become a one-stop-shop for clients to always find the latest clinical communications.”

With specialty pharmacy the fastest growing cost within healthcare, we’ve opened a new specialty pharmacy to ensure we have the capacity, pharmacy services and clinical staff to efficiently meet growing demand for these specialized medications.

Welcome to Chandler, AZ, known as the Innovation and Technology Hub of the Southwest! Chandler has a rich history in high-tech manufacturing and development that dates back 50+ years, making it a great location to expand our specialty capabilities. Opened in November 2018, we’ve only scratched the surface of the capabilities of our new 88,000 sq. ft., high-tech specialty pharmacy.

“At present, we have 45 people working in the specialty pharmacy, but that number will grow as we add therapies” says Kirk Curtis, our leadership team member responsible for opening the facility. “Not only is this a great location to more efficiently serve the west coast, it’s a great market to recruit highly educated employees with technical and clinical experience.”

“With the climate in Arizona, we don’t have the weather issues that impact the East Coast, Midwest and southern states,” Kirk adds. In today’s world, redundant operations to ensure uninterrupted service and delivery for patients across the country are critical. The building itself is only 3 years old, with an advanced infrastructure and state-of-the-art dispensing unit. We’ve also equipped it with redundant data storage capacity. When we base our capacity planning on industry trends, we ensure we can scale our business in a timely manner to meet your needs.

We’re excited to introduce you to Cornell Beck, our new CastiaRx Associate VP and GM of Mail Order. Known in the industry as a client-focused senior leader and change agent, Cornell combines 20+ years of leadership expertise in healthcare and business settings with a keen understanding of people, processes and IT technology. He is well equipped to lead the charge to care for you and your members.

“From the first call with a plan member, we drive for the highest satisfaction to wow them,” Cornell says. “Our role is to understand client objectives, assess member needs and ensure the team is well equipped to deliver the positive experience members should expect.” With a strong background in Lean Six Sigma, Cornell knows how to manage a mail order pharmacy and surpass expectations for operational effectiveness.

With Lean Six Sigma, measurements are in place, people are equipped to succeed in their roles, technology is deployed, and processes are documented and scalable to deliver a seamless experience. In previous roles, Cornell led PBM call center operations, performance strategies, quality assurance, training initiatives, utilization management, formulary management and business analytics across multiple lines of business. “Members want their calls answered quickly and their mail order prescriptions delivered in a timely manner. That’s really what it’s all about,” he concludes. “That’s the kind of service we will deliver.”

Your plan members are more connected than ever, using digital technology in nearly every aspect of daily life. They expect the same convenience when managing their health. CastiaRx is excited to provide a robust digital Member Center to help them leverage the power of prescriptions in fighting disease and maintaining their health! Using the latest technology, it’s easy for members to keep track of prescription information with:

• Enhanced home delivery features that now make it easy for members to order refills, choose auto refill and track prescriptions.
• Tools to make better choices. Using Medication Lookup, members can check formulary coverage, find alternatives that save money, review drug interactions and check side effects.
• A look-up tool to compare prescription costs at different pharmacies – coming soon!

Of course, our Member Center offers all the basic features you’d expect. Members can manage medications for the entire family, get an electronic pharmacy ID card, find the nearest network pharmacy, filter their prescription history and more. Your members can register online for the Member Center at MemberCenter.CastiaRx.com or download our mobile app.

Having one place to go for everything helps members choose the right drug at the best price. The Member Center will continue to evolve with new features. Future issues of The Edge will keep you up-to-date on functionality we add throughout the year.

*The vast majority of CastiaRx clients now have access to the Member Center. If your plan has not yet migrated to RxClaim, your members can use the Member Center once you make the switch.