2023 PCP Reward Plan – Pharmacy Spotlight
March 31st, 2023 | Network NewsAs our network’s practices and providers settle into the 2023 performance year, AHP would like to place renewed emphasis on the new PCP Reward Plan. To ensure that network providers understand their accountabilities under the plan and are familiar with the resources available to help them improve quality and optimize incentives, we will feature a deeper dive into a different component of the reward plan in each issue of Network New. This month our spotlight is on the Pharmacy Savings Program, a cost-savings initiative that will apply to eligible adult primary care providers.
The 2023 Pharmacy Savings Program focuses on switching patients to less costly alternatives in four medication classes when clinically appropriate: Insulin Lispro, Long-Acting Insulin, Metformin ER, and NSAIDs.
Providers earn the maximum incentive when their rate of prescribing lower-cost alternatives for each medication class is better than the established overall network baseline.
For providers whose performance is lower than the network baseline, a portion of the incentive can still be earned so long as the performance represents an improvement from the provider’s prior year individual performance. Providers will also have an opportunity to collaborate with the Pharmacy team to identify patients for whom switching is clinically inappropriate to remove those patients from the provider’s performance calculation. The 2023 Pharmacy Savings Program is identical to the 2022 performance year to allow for more robust engagement, which was limited last year due to data disruptions and delays.
Like all other components of the PCP Reward Plan, providers can monitor their Pharmacy Savings Program performance using the Provider Engagement Report (PER). In addition to a snapshot view of overall performance, providers can easily identify and download a list of patients eligible to switch to a less costly medication. Recently AHP’s Director of Pharmacy Services, Bob Adams, provided an overview of the 2023 Pharmacy Savings Program, including navigating the PER’s pharmacy section, which can be viewed in our recording of the March AHP Update Call. If you have questions about this year’s pharmacy program or your individual performance relative to the pharmacy initiatives, please contact Bob Adams.
For general questions about the Provider Engagement Report, please email [email protected].
For questions about the PCP Reward Plan, contact your provider relations rep, Jana Darlington or Renée Sutton.
