Specialty Rx Solutions:

Cost Management

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96%

Total reduction in NET medication costs

$17K+

$17,300 in per month savings for the plan & member

$700

Reduced total medication cost to $700 per month

The Situation

INDUSTRIAL CONTRACTOR

134 EMPLOYEES

One of our brokers had an industrial client who saw their pharmacy spend climbing year over year. The incumbent PBM program restricted the client’s ability to access real-time prescription drug information.

This often resulted in months of high-cost medications filled without the plan manager’s knowledge. When limited data was provided about high-cost claims, the incumbent PBM failed to offer solutions to resolve escalating pharmacy claims costs.

Due to the lack of transparency and cost-containment solutions with their incumbent PBM, the company made the switch to Crumdale Partners’ pharmacy benefit management program.

Goals

CLIENT:

Obtain a clinically integrated PBM solution that identifies the necessary opportunities while promoting a cost-effective pharmacy program.

BROKER:

Obtain transparency and cost containment for the client through Crumdale’s specialty Rx sourcing solutions and claims process.

Specialty RX Case Study | Crumdale Partners

The Results

The group saw a 96% reduction in NET medication costs, offering $17,300 in monthly savings. Crumdale lowered the total monthly costs from $18,000 to $700 a month and identified a member for alternative drug sourcing who initially would have been charged $5,000 per fill under the previous HDHP plan.

Pricing

FAVORABLE DISCOUNTS, TERMS, AND CONDITIONS

Stability

DECREASED RENEWAL VOLATILITY

Control

ALLOWS FOR STRATEGIC PLANNING & FINANCING

How We Did It

The client had many issues with their prior pharmacy benefit manager (PBM), which Crumdale solved by implementing the following:

Superior Pricing

High-Cost Drug Support

Specialty Drug Sourcing

Active Claims Monitoring

Claims Negotiation

Real-Time High-Cost Claim Management

Specialty RX Case Study | Crumdale Partners

PROCESS

  • We actively monitored all claims for new high-cost medications.
  • Once identified, we immediately notified the broker and employer to discuss potential solutions.
  • The broker and employer agreed to move forward and engage the member.
  • We worked with the member, physician, and pharmacy to facilitate the high-cost medication alternative sourcing, resulting in significant savings for all parties.
  • The exact medication prescribed was filled at a fraction of the cost at the newly introduced pharmacy.

CRUMDALE’S PHARMACY DIVISION, WORKED WITH THE BROKER AND CLIENT TO PROVIDE SPECIALTY DRUG SOURCING WITH OUR PROVEN CLAIMS PROCESS.

RESULTS

  • Within the first two months, our pharmacy benefit management team identified a high-cost specialty medication at $18k a month. The member enrolled in the HDHP was responsible for paying $5k monthly.
  • The TRx team supported the group and the member by immediately evaluating potential alternative solutions that would lower the plan and member s drug cost.
  • TRx was able to redirect the member to obtain the medication through an alternative contracted pharmacy, which cost only $700 a month, resulting in over a $17K reduction in plan cost per month ($130 PMPM) and prevented a spec hit. Additionally, the plan agreed to remove all member costs.

“CRUMDALE PARTNERS’ EFFORTS HELPED US MAKE THE BEST OUT OF A BAD SITUATION. WE REALIZED SIGNIFICANT SAVINGS. CRUMDALE’S ABILITY TO IDENTIFY THE PERSCRIPTION AND REACT SWIFTLY WAS IMPRESSIVE, AND OUR HR TEAM WAS ABLE TO MAKE IT EASY FOR OUR EMPLOYEES TO DO THEIR PART.”
-HR Director

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