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FERTILITY OVERVIEW
PROVIDER RELATIONS
PHARMACY MGT
COVERED BENEFITS
MGT SERVICES
Fertility Pharmacy Management
Fertility Pharmacy Management Services
WIN is not a pharmacy. WIN manages pharmacies and has created a network structure that works in states with and without “any willing provider” and “freedom of choice” laws. WIN’s pharmacies are a network of specialty pharmacies that specialize in dispensing infertility pharmaceuticals. These pharmacies must meet a strict set of standards and have a separate agreement with WIN that requires the pharmacies to maintain these standards plus meet the requirements that the health plan and WIN have determined. These pharmacies may continue to have an executed participating provider agreement with either the health plan and/or its PBM. WIN amends its existing arrangements with participating pharmacies to meet the agreed upon standards between the health plan and WIN. WIN would work with the health plan to customize its standards in an effort meet both internal health plan policies and state law and regulations.  

Unlike pharmacies, whose profits are generated through the volume of pharmaceuticals dispensed, WIN has no incentive to dispense more medication than is needed. In fact, although many pharmacies may describe how they perform dosing management, under WIN’s supervision these same pharmacies dispense fewer drugs because of the tighter controls generated by WIN’s management systems. These systems incorporate a multi-layer screening process that reduces the total volume of pharmaceuticals dispensed by strictly enforcing the plan’s benefits, eligibility, state mandates, related clinical procedures and protocols. Medications represent at least one third of the cost for infertility services depending on the design of the benefit and lack of controls. For treatments such as Ovulation Induction and Intrauterine Insemination, pharmaceutical costs are more than two-thirds of the cost of treatment. In addition, many other costs are associated with infertility drug therapy because it is monitored through frequent lab tests, ultrasounds and professional office visits. Our system is designed to address issues related to costly dispensing practices as well as to identify trends related to the excessive utilization of hormone drugs which can result in expensive multiple gestations.