Finding a balance to manage the escalating cost of benefit programs has never been more challenging.

The Clinical Service Team, comprised of experienced licensed pharmacists, offers the following value added customized cost-containment solutions.

Click on a link below for more information:

• Drug Utilization Review
  
• Formulary Management
  • Plan Descriptions
    
• Special Authorization
  • Special Authorization Forms
  • Special Authorization Criteria
    
• Health Education
  
• Rx&D Services

Offering a suite of over 30 formularies, ClaimSecure’s drug plans include the traditional prescription plan, prescribed plan, or government formulary plan. In addition, ClaimSecure recommends the most appropriate managed drug formulary, which limits access to new, expensive medications, while maximizing the use of more cost-effective drugs. Our team of clinical experts reviews all new drugs coming to market, and can help you decide whether they should be covered under your plan.

For detailed plan descriptions of some of ClaimSecure’s popular drug plans, please click here.

Using established clinical criteria, ClaimSecure offers a special authorization program designed to assist clients limit member access to high-cost drugs, while maximizing drug benefit dollars. Our Clinical Service Team supports plan sponsors in setting the approval criteria, thus, members who meet the approval criteria will receive the medication they require. This process reduces drug benefit cost while ensuring that members receive the most appropriate and cost efficient drug therapy.

If a member goes to the pharmacy with a prescription for a Special Authorization drug, it will be declined with the message " DIN Not Covered, May Require Special Authorization". The process to obtain Special Authorization drug approval is as follows:

• Obtain special authorization form from ClaimSecure website Forms library, or by calling bilingual national call centre at 1-877-479-3784 (4RX-DRUG) or at 1-888-513-4464.
• Take the form to the doctor for completion if the member meets the clinical criteria. For detailed clinical criteria, please click here.
• Return the completed form to ClaimSecure’s Clinical Service Department by mail or fax.
• ClaimSecure will reply within 10 working days upon receipt.

ClaimSecure’s education program is flexible and can be tailored to meet the client’s needs. The education program can take the form of a lunch & learn seminar or a general distribution of information on a particular disease state. The program’s objective is to provide relevant health information to members, individualized follow-up care when appropriate and measurement of outcomes.

ClaimSecure’s Lunch and Learn Seminars:

• General health
• Stress
• Back and Muscle Strain
• Cold & Flu
• Migraine Headaches
• Heart
• Asthma
• Stomach
• Smoking cessation

In addition, ClaimSecure has developed bilingual, Internet based health education and intervention programs through the sponsorship of various industry stakeholders. The following modules of health information and disease intervention programs are available through ClaimSecure’s Health Library:

• Depression and Anxiety
• Heart Burn/Stomach Ulcer
• Your Bone Health
• Arthritis
• Cholesterol
• Diabetes
• Your Weight/Your Health