While most are familiar with pharmacists and pharmacy technicians who work at local drug stores, did you know health plans typically have their own pharmacists and pharmacy technicians? Though they aren’t filling prescriptions, health plan pharmacy teams are there to support members with anything from questions about medications to working with providers and retail pharmacies on behalf of a member.
We connected with Heather Schramm and Puja Malaviya, two pharmacy technician specialists at our parent company Point32Health, to learn how they support members across our lines of business at Harvard Pilgrim and Tufts Health Plan.
How pharmacy technician specialists work with members in care management
Certified pharmacy technician specialists like Puja and Heather, who work under the supervision of a licensed pharmacist, help members in a variety of ways, particularly when it comes to medication adherence. Often, they start by outreaching to members who have been identified by a nurse care manager, pharmacist or provider as potentially having a medication-related challenge. For example, maybe someone has recently started a new medication and may be unfamiliar with what to expect or have questions about their benefits, like understanding why a prescription was denied. And there are also instances, for those who are on multiple medications, where Heather and Puja refers to a licensed pharmacist for a medication review to provide insight on how those medicines are affecting one another. Heather notes that a member could have multiple providers and pharmacies, but those parties are not necessarily communicating with one another to understand what medications the member may already be on.
“We’re kind of like the middleman because we can see what all the pharmacies are submitting, as well as the prescribing providers—so we get a holistic picture.” – Heather Schramm
With that holistic picture, the pharmacy technician specialist can serve as the point person between member, provider and retail pharmacist. For instance, it can sometimes be difficult for members to get in touch with their providers to request a refill, something Puja says can take multiple calls and long hold times before getting through depending on the office. This is where our pharmacy technician specialists can jump in to alleviate the burden of the member by reaching out directly to the provider. They’ll also get in touch with the member’s pharmacy if a refill is out-of-stock or offer suggestions for financial aid resources if a member can’t afford a medication The pharmacy team is part of Harvard Pilgrim’s broader care management team and collaborates with a team of social workers, nurse care managers, behavioral health care managers, care coordinators, community health workers and peers to ensure that members receive the support they need. The pharmacy team works with members by referral from any member of the care management team.
“It’s really nice, internally and externally, having a team supporting you; we may be helping different lines [of business], but internally as a pharmacy team we’re always bouncing ideas off each other to help members.” – Puja Malaviya
Pharmacy support straight to your door
For those that may need additional help managing their medications, members of the pharmacy team—like Heather, Puja or a pharmacist—will work with the member right in their home. Being able to assess the situation in-person gives them a better understanding of if a member is taking their medicine, how their managing their meds (with or without a pill container) and the option to answers medication questions on the spot.
The face-to-face interaction helps to build a relationship with members, sometimes resulting in more regular visits and phone calls if a member is unable to fully manage their own medications and doesn’t have a support system to help them. Heather recalls working with a member who initially relied on his girlfriend to manage his medications and place them in a pill organizer; however, upon their breakup, Heather went to his home to get his medicines organized and enroll him in a pill pack service that automatically sent him his exact pills sorted for each day and time he needed to take them. She also suggested ways for him to better remember to take his medicine, like placing his pill pack next to his chair while he watched the news and setting an alert up through his TV provider to come across his screen when it was time for his medicine.
“I love working with members. I love having that actual conversation. I don’t look at members as a number…this is about actually helping them improve their overall health.” – Heather Schramm
Puja shares a similar sentiment when telling a story about helping a member with diabetes, COPD and a number of other conditions get the medication that he was unexpectedly unable to afford. After being told medications he was previously taking were no longer covered by insurance, Puja visited the member in his home to walk through every document he had that could help set him up with the proper financial assistance options so he could afford his medication.
“I get a lot more joy out of helping the people who didn’t know services were available…you hear the change in their voice when you actually give them an answer and a resolution.” – Puja Malaviya
How to connect with Harvard Pilgrim
If you’re a Harvard Pilgrim member already working with a nurse care manager or social worker, ask about Harvard Pilgrim’s care management pharmacy team—or if you’re interested in learning more about the care management program and eligibility, call Member Services at (888)-333-4742.
