Specialty Rx
Cost Management
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
Transformation Rx, the pharmacy division of Crumdale Partners.
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.
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 Results
Immediate 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.
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
Crumdale’s Pharmacy division, Transformation RX, worked with the broker and client to provide specialty drug sourcing with our proven claims process.
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.
Example
- Within the first two months, Transformation Rx 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