WorldCare ACCESS SpecialtyRX (Specialty drug second opinion service)

WorldCare ACCESS SpecialtyRX
Remote second opinion service

 

The need

The rapidly increasing complexity and sky-rocketing costs of specialty drugs are straining medical networks and presenting patients with unique delivery and side-effect issues. In countries such as the United States, Canada and Australia, specialty drugs represent approximately two percent of claims1. Yet this accounts for more than thirty percent of total medication expenditures and continues to rise.

 

  • In Canada, 42 percent of drug spending, or $5.6 billion, will be on specialty drugs by 20202
  • In the United States, spending on specialty drugs has increased by $54 billion dollars over the past five years, accounting for 73 percent of all medicine spending growth3
  • In Australia, the government spent more than $311 million dollars on just 176,062 Adalimumab (used to treat arthritis and Crohn’s disease) prescriptions between July 2014 and June 20154

 

The solution

WorldCare ACCESS SpecialtyRX service is available globally and utilizes a multi-disciplinary evaluation of the underlying medical condition by first conducting a sub-specialist remote second opinion from a top-ranked U.S. hospital of the WorldCare Consortium®. Then, an enhanced specialty drug second opinion is completed by a PhD pharmacy expert from the WorldCare Consortium®.

 

Unique features
  • Multi-layer review of both underlying medical condition and specialty drug issues
  • Rapid access to leading medical and pharmacy experts at WorldCare Consortium® facilities
  • Institution-based, multi-disciplinary remote second opinion
  • Multi-institutional review if required
  • Rigorous record collection and outreach to all health professionals in the specialty drug care team
  • Video-enhanced service if needed
  • Physician-to-physician guidance with WorldCare support throughout the process
  • Follow-up questions available up to 30 days after initial review

 

Key features
  • Comprehensive engagement with member and specialty drug care team, ensuring the most important issues are addressed
  • Crucial top-level guidance in suggesting alternatives and cost-containment possibilities
  • Leveraged knowledge and long- standing virtual pharmacological experience of the WorldCare Consortium® facilities and their experts

 

 

How it works

 

Step 1  The eligible member calls or completes an online form to request service.

Step 2  WorldCare works with the member, their specialty drug care team and their designated physician(s) to gather medical records and sends them to the medical institution best suited to review their case.

Step 3  The medical specialists, along with the pharmacy experts, review the member’s records and diagnostic material and provide the independent second opinion to the member and their treating physician.

 

Benefits
  • Improved member care and well being
  • Virtual management of side effects and drug delivery issues
  • Evaluation and one-on-one guidance for choosing the best drug option
  • Alternative choices in both pharmacological-therapeutic and non-drug modalities interventions
  • Cost containment for insurers and employers
  • Less expensive alternative for members and their treating physicians

 

Covered conditions

Conditions eligible for the WorldCare ACCESS SpecialtyRX service are determined on a client-by-client basis.

 

Our mission is to improve healthcare outcomes of patients worldwide by connecting our clients to the foremost medical experts at top-ranked U.S. hospitals. And, with over 22 years of experience, our expert medical second opinion service is the gold-standard. Our unique partnership with the top-ranked hospitals in the U.S., The WorldCare Consortium®, along with teams of specialists within these hospitals, enables us to provide expert medical second opinions of an unmatched clinical rigor and depth. We help thousands of members worldwide and their treating physicians have the confidence that their diagnosis is correct and that they are on the optimal treatment plan while reducing overall healthcare costs.

 

For more information, please call WorldCare at 866.399.9262 or email us.

 

WorldCare ACCESS SpecialtyRX service spec. sheet

 

 

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  1. http://www.pewtrusts.org/~/media/assets/2016/12/specialty_drugs_and_health_care_costs.pdf
  2. http://www.express-scripts.ca/node/431
  3. IMS Institute for HealthCare Informatics. (2015, April). Medicines Use and Spending Shifts: A Review of the Use of Medicines.
  4. https://www.businessinsider.com.au/here-are-the-most-used-and-most-expensive-drugs-in-australia-2016-8#1