Magazine article Drug Topics

Diagnostek Offers Capitated Program to HMO Customers

Magazine article Drug Topics

Diagnostek Offers Capitated Program to HMO Customers

Article excerpt

A major third-party plan administrator claimed it is offering health maintenance organizations the first truly managed care approach to handling their drug benefit by guaranteeing a cap on costs.

The administrator, Diagnostek Inc., Albuquerque, N. Mex., said its program, RxChoice Plus, caps drug costs for HMO clients on either a per-prescription or per-member basis.

"Under RxChoice Plus, we are going directly to the HMOs and offering them a capitated product for the complete delivery of their pharmacy benefit," said Duke Rodriguez, COO for Diagnostek. The company handles pharmacy claims nationwide for about 7.7 million patients in a variety of health-care programs.

RxChoice Plus will hold down drug benefit costs for HMO clients with the help of such managed care tools as formularies, generic substitution, physician education, and a drug utilization review system.

"We will manage their formulary. We will develop their network. We will do their claims processing. And we will do their utilization reporting. We will do it under a capitated environment. We will take the risk, and the plan will benefit from the cost savings," Rodriguez said.

In other words, if Diagnostek fails to keep pharmacy costs within the preset amount promised to an HMO, then Diagnostek will pay the difference. …

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