RX Advocates:

From High Cost to Free of Charge

1 Member

Identified for high-cost drug management and alternative sourcing

1 RX

Filled free of charge through a Manufacturer’s Assistance Program

No Disruption

No missed medications, thanks to our Patient Assistant Program

The Situation

One of our clients is a small, self-funded organization with fewer than 30 employees. During the annual plan renewal, their stop-loss carrier identified a member who was recently diagnosed with an orphan condition that required a maintenance medication costing $300,000 annually.

Based on this staggering amount, few stop-loss carriers were willing to quote their business, and if they did, they provided lasers on the high-cost medication.

With this feedback, the company began to strongly consider returning to a fully-insured plan. They decided to meet with their broker and Crumdale Partners to discuss potential solutions.

Crumdale implemented a program that allowed the employer to alternatively source high-cost specialty drugs at substantially reduced costs.

Goals

CLIENT:

The client asked their broker to help find a way to reduce the high costs of the newly identified orphan medication.

BROKER:

The broker worked with Crumdale to develop and implement a specialty Rx cost-containment strategy to lower the drug’s costs for the client.

The Results

By proposing a new PBM and stop-loss vendor through Transformation Rx, we were able to identify an alternative sourcing solution and provide the high-cost medication free of charge to the member and at an 80% discount for the employer.

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 AND STOP-LOSS CARRIER, WHICH CRUM DALE SOLVED BY IMPLEMENTING THE FOLLOWING:

High-Performing Rx Contract

Experienced Stop-Loss Carrier

Patient Assistance Program

Specialty Rx Sourcing Solutions

CRUMDALE’S PHARMACY DIVISION, TRANSFORMATION RX, WORKED WITH THE BROKER AND CLIENT TO PROVIDE ALTERNATIVE DRUG SOURCING WITH NO MEDICATION DISRUPTION.

PROCESS

  • Crumdale proposed a new PBM vendor and stop-loss vendor.
  • Crumdale identified an alternative sourcing solution to provide the high-cost medication directly to the member free of charge and at an 80% discount for the client.
  • Crumdale implemented a high-performing PBM contract to allow for the alternative sourcing solutions.
  • With the solution in the works, Crumdale assisted the client and their broker in identifying a stop-loss carrier that would provide a quote with a conditional laser based on the alternative sourcing.
  • Prior to implementation, Crumdale assisted the member in applying for our Patient Assistance Program, which ensured there was no disruption in receiving their medication.

RESULTS

  • Transformation Rx, Crumdale’s pharmacy division, reviewed the intricate case and identified alternative sourcing solutions for the high-cost member.
  • Once the savings were identified, TRx immediately notified the broker and group to discuss potential solutions.
  • The broker and employer agreed to move forward with next steps and engage the member.
  • TRx’s clinical staff spoke with the member, physician, PBM and drug manufacturer to facilitate the high-cost medication to be filled through a Manufacturer Assistance Program.
  • Once the cost was approved, the member was able to receive the high-cost medication directly from the manufacturer free of charge.

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