CARE Program Wins by Putting Member’s Needs First

CARE Program Wins by Putting Member’s Needs First
August 23, 2022 Sue Riordan

Danielle has a condition that takes a big toll on her health.

Known as pulmonary arterial hypertension (or PAH), it’s caused by a narrowing of the arteries found in her lungs. This makes her heart work extra hard to keep her body going. Just doing day-to-day activities—like simple chores, taking a walk or doing work in the garden—leave her feeling very tired and out of breath.  If untreated, Danielle’s PAH can also be quite serious.

To help her feel better, Danielle uses a prescription drug therapy her doctor recommended. Since beginning treatment, she’s noticed a huge relief in her symptoms and better quality of life. The treatment is expensive, though. And to administer the medication properly, she needs several different supplies delivered on a regular basis.

Until recently, Danielle had been using a nearby specialty pharmacy to get her supplies. But, her health benefits through work just changed, which meant changing to a new pharmacy, too.

Danielle was apprehensive to go somewhere new.

She’d been having an easy time refilling prescriptions and getting what she needed on time. Plus, her current pharmacy was close to home, which gave her extra peace of mind.

Despite her reservations, Danielle gave the new in-network pharmacy a try. However, after a few months, she hit some bumps in the road trying to manage her condition. The new pharmacy was struggling to ship orders on time. Also, a few orders had items missing, due to supply issues. The situation was incredibly stressful for Danielle since she couldn’t have her therapy without all the supplies in hand.

Luckily, Danielle’s health benefits included access to Meritain Health® Pharmacy Solutions (MPS) and the CARE Program. A CARE specialist was alerted and took steps to address these issues.

As a priority, the CARE team wanted to rush any supplies to Danielle that she hadn’t yet received. They knew missing treatments could land Danielle in the hospital or be life-threatening.

By making the right calls, CARE team members were able to expedite shipping of the correct supplies directly to Danielle. They even coordinated with her prior pharmacy to fill out-of-stock items.

This quick work helped remedy the frustrating situation for Danielle. However, the CARE team wanted to make sure Danielle’s long-term health would be protected as well.

With the approval of her employer, CARE allowed an exception for Danielle’s medication and supplies. Going forward, she could simply use her previous pharmacy to fill all future prescriptions.

Danielle was so excited to hear this, and her employer was happy, too! Both were grateful to use pharmacy benefits with such integrity and a high value placed on employee health.

This story is based on an actual member experience. Names and information have been changed to protect the member’s privacy.

This communication is intended for informational, promotional purposes only. The reference to previous outcomes made as a part of this communication does not guarantee success or similar outcomes in any new or future cases, as the result of each case depends upon many factors, including but not limited to the facts of each case. Any actual savings will vary based upon numerous factors, and neither Meritain Health nor its affiliates guarantee any level of savings.