PerformRx has a comprehensive management program for members requiring authorization for factor products. The bleeding disorders program includes utilization review, case management and specialty pharmacy network management. The Specialty Drug Management department reviews all requests for factor products administered in a member's home in an effort to ensure compliance, minimize product overstocking, and monitor utilization.
A nurse case manager works with the bleeding disorders population to provide support to members needing information and care regarding their disorder. Case management support includes coordination of services for health care issues, as well as locating community resources; and functioning as a liaison between the member, the specialty pharmacy network, and the hemophilia treatment center/provider. The nurse case manager is also responsible for regular telephone contact and, if applicable, home or off-site visits with the member.
Requests for factor drugs must be submitted on the Hemophilia Request form and faxed to the PerformRx Specialty Drug Program.
Medications that are subject to review include:
- Factor VII (Novoseven)
- Factor VIII
- Factor IX
- Anti-inhibitor coagulant complex
A four-week supply is typically approved for patients receiving prophylactic treatment. Medication may be approved on an as-needed basis for patients requiring replacement medication for drug therapy that was administered for treatment of episodic bleeding. Associates in the PerformRx Specialty Drug Program will coordinate the delivery of factor to members via authorized specialty pharmacy providers.
EACH REQUEST for factor product MUST BE ACCOMPANIED BY THE FOLLOWING:
- Completed order request form (including current weight)
- Physician order (needed with every request)
- Administration/Bleed logs
The Procedure for Requesting Hemophilia Medications is as follows:
- The provider must submit a completed hemophilia factor order request form and a prescription from the doctor for all initial factor requests.
- All subsequent requests for refills require:
- Completed hemophilia factor order form.
- Copy of the physician's current prescription.
- The member's Administration/Bleed log in order to determine the appropriate amount of medication to be replaced.
