Initial Therapy Protocol

For clients that have elected to use the Select 90 Rx network, MaxCare has developed an innovative tool called Initial Therapy Protocol.

Goal

The goal of initial therapy protocol is to avoid wasting very costly medications, while providing patient convenience on established medication therapies.

Rationale

It is difficult for the doctor and pharmacist to predict the patient's tolerance for a medication or what strength of the medication will be sufficient to treat the patient’s condition without causing side-effects. During the initial days of therapy, the patient’s first prescription is limited to a one-month supply until it is known whether the drug and regimen will meet the patient’s specific needs. Once it is established that the medication works and is well tolerated, patients may receive up to a 102 day supply (some plans use 90 day increments instead) of medication , as long as they refill their medication on time and as prescribed by their doctor.

Initial Therapy Criteria

Initial Therapy of no more than a 34-day supply (certain plans use 30-day increments instead) within 120-day period is required  for beginning therapies and in each instance when the drug strength is changed, to ensure that the patient tolerates the therapy well and that medication changes do not result in wasted doses.