Frequently Asked Questions

  1. Q1.
    What is Whole Health Rx?
    A.

    Whole Health Rx is an integrated pharmacy management solution designed to help you manage your patients’ mental and physical health. Targeted patients have behavioral health disorders and common co-morbid conditions, such as heart disease, diabetes, asthma, etc.

  2. Q2.
    How can you help me manage my patient’s mental and physical health?
    A.

    Whole Health Rx provides information about medications to assist you in your efforts to provide safe, appropriate, and cost-effective care to your patients through multi-channel consultations and educational materials. We provide patient-specific data obtained through our monthly review of medical and/or pharmacy claims, and have an online Patient Quality Tool to help you check patient health status as well as prescribing information.

  3. Q3.
    What is the goal of Whole Health Rx? Why is my participation important?
    A.

    Our goal is to support providers, like you, when prescribing behavioral health medications and help you provide expert quality of care. By focusing on behavioral health disorders and their co-occurring physical health conditions, we can help you optimize your prescribing practices for improved patient safety and overall well-being.

  4. Q4.
    How does Whole Health Rx work?
    A.

    Whole Health Rx is a monthly provider outreach that utilizes hundreds of proprietary clinical algorithms which are applied, retrospectively, to medical and/or pharmacy claims. These claims are provided by our health plan clients each month so we are able to capture patient-specific information related to prescribing and utilization scenarios that may be inconsistent with our identified best practices. 

     

    If an algorithm is triggered, a unique combination of attributes has been met and results in identifying outlier prescribing behavior. A message is then generated and listed in a printed report that shows the patient-specific quality opportunity. Providers may be contacted directly for a personalized consultation if the system identifies them as needing additional guidance on prescribing patterns or clinical guidelines. We understand that data can only provide part of the clinical picture and your judgment may require practices outside of guidelines for special situations.

  5. Q5.
    Whole Health Rx provides patient-specific data to providers – how will this information be distributed to me?
    A.

    The Whole Health Rx program produces a report that we refer to as a “packet.” Packets are distributed to certain providers by mail, fax, or email. A subset of providers may be selected to receive a consultation. Consultations are conducted in a face-to-face visit at your office, by telephone, or virtually, via webcam. All consultations are scheduled with you at an agreed upon date and time.

  6. Q6.
    How are Whole Health Rx packets created and why would I receive one?
    A.

    Packets are created by analyzing medical and/or pharmacy claims data using proprietary protocols that are built from evidence-based guidelines and FDA-approved labeling. A summary of your prescribing patterns as they relate to specific medication guidelines will be included in the packet, along with patient-specific information and possible actions to take. Our protocols promote prescriber adherence to established national guidelines, such as:
    • Gaps in care;
    • Excessive dosing;
    • Subtherapeutic dosing;
    • Duplicative prescribing;
    • Unendorsed pediatric prescribing;
    • Unendorsed geriatric prescribing;
    • Generic substitution and generic same class optimization; and
    • Inefficient dosing regimens.

    Our comprehensive medical and/or pharmacy data analysis process monitors physicians’ prescribing patterns for various therapeutic classes. You will receive a packet if our process identifies prescribing behaviors that trigger one or more of the algorithms.

  7. Q7.
    Who conducts the Whole Health Rx consultations?
    A.

    We utilize clinical pharmacists specifically trained in behavioral health pharmacology and who have experience collaborating with medical practitioners to summarize and guide in evidence-based prescribing practices. Our pharmacists are dedicated to each client account and we encourage you to build a relationship with the pharmacist dedicated to you.

  8. Q8.
    Does Whole Health Rx contact patients?
    A.

    Currently, outreach to patients is not part of the program. It is important that the program does not interfere with the doctor-patient relationship.

  9. Q9.
    Is there a cost to prescribers or patients to participate in the program?
    A.

    There is NO cost to prescribers or patients to participate.

  10. Q10.
    What if I received a packet for a patient that I am not treating and do not wish to receive future correspondence regarding intervention reports for this particular patient?
    A.

    Our program received claims data from the patient’s health plan indicating a prescription was filled with your name identified as the prescriber. Please contact your pharmacy consultant or call 1-800-243-3771 to report this issue so we can make the necessary system updates. You are also encouraged to reach out to the pharmacy to request a correction on the prescription.

  11. Q11.
    Who do I contact if I have further questions about Whole Health Rx or would like to request a consultation with a pharmacist?
    A.

    If you have questions about this information or would like to schedule an individualized consultation with a pharmacist specialized in behavioral health, please contact us at 1-800-243-3771 or by e-mail us at pharmacyconsultation@magellanhealth.com.

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