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Pharmacy Services Department

This Department is responsible for ensuring the quality of drug procurement and usage through effective pharmacy practice. Pharmacy Clinical Operations are carried out by a team comprised of experienced doctors in Medicine and Pharmacy, as well as certified pharmacy technicians and registered nurses that leverage clinical discussion through communication and interventions with healthcare providers.

Our department employs a number of strategies focused on the drug formulary, Medication Therapy Management (MTM), the Drug Adherence Program and other clinical programs and tools aimed at improving drug benefits, and monitoring drug safety, while maintaining operations in compliance with CMS and any applicable law or statute. Our ultimate goal is to provide care coordination and improve health outcomes for all valued health plan members.

Pharmacy Department’s main objectives are centered in:

  • Improving the quality and cost-effectiveness of drug procurement available through our formulary. 
  • Identify and anticipate market trends that may impact or favor our formulary options.
  • Apply analytical tools that can allow for daily monitoring.
  • Promote intensive monitoring of our providers’ performance to ensure that the quality of services to all our members is sustained.
  • Expand the scope of the Drug Therapy Management Program by working with the social determinants of our population.
  • Integrate pharmacy procedures into the medical process to ensure that drug-related problems are identified and eliminated. 
  •   Incorporate the pharmacy providers as a key figure for performing drug therapy reconciliation, closing care gaps, and increasing drug adherence.
  • Work directly with the PCP/IPA to manage risks and close care gaps.
  • Direct care to patient (VitaCare/MTM) in order to manage pharmacotherapy and ensure continuity of services. 

The Pharmacy Operations Support Unit assists all initiatives involving monitoring of operations’ compliance to CMS and internal requirements, as well as project management of technology initiatives pursuing efficiency and customer satisfaction.

Primary care providers who are supported by our preventive approach have measurably successful results:

  • 20-45% lower admission and readmission rates
  • 30% below average and avoidable ER visits
  • 63% average increase in Annual Health Assessments, which helps to gather more detailed information of their patients for quality care
  • 95% AHA completion year after year