A Big Carrier Made Big Promises.
Guess Who Actually Delivered?
Questions to ponder:
So much for promises. Failed Remedies Disappoint
How did it go? Despite the carrier’s reduced fees, the company’s pharmacy plan costs continued to rise, from $60.25 per member, per month (PMPM) with RxBenefits to $90.21 PMPM with the carrier. The lower fees didn’t help to counter the effects of drugflation or address the root of the company’s problems: specialty spend.
Q1 2021*
(With RxBenefits)
$60.25 PMPM
36.8% Attributed to Specialty
*Q1 2021 based on last full quarter client was with RxBenefits
Q3 2022*
(With Carrier)
58.3% Attributed to Specialty
*Q3 2022 based on last full quarter of claims client provided for analysis while with carrier
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Shortcomings of the Carrier Model: Critical Limitations with Costly Consequences
From big talk to meaningful action. Finding a Sustainable Cure
The company knew who to turn to – or who to return to – to regain control and achieve its critical plan savings goals. In 2023, they re-engaged RxBenefits, opting to carve back out. Leveraging RxBenefits’ member-centric, pharmacy-focused approach, the transition unfolded seamlessly. The company regained flexibility along with data and contract transparency and restored independent clinical management to manage its plan to the lowest net cost.
Pharmacy costs fell dramatically
The benefits and finance teams felt more secure in the hands of a trusted partner.
Q1 2021*
(With RxBenefits)
$60.25 PMPM
36.8% Attributed to Specialty
*Q1 2021 based on last full quarter client was with RxBenefits
Q3 2022*
(With Carrier)
$90.21 PMPM
58.3% Attributed to Specialty
*Q3 2022 based on last full quarter of claims client provided for analysis while with carrier
Q3 2023*
(With RxBenefits)
44.7% Attributed to Specialty
*Q3 2023 based on first full quarter client was back with RxBenefits
Their RxBenefits Solutions
Read more about the specific clinical solutions implemented to help achieve lowest net cost.
Click on each dot to see each solution.
Independent Prior Authorization Management
PharmD-led reviews of high-cost prescription claims in context of chart notes to ensure prescribed medications are both clinically appropriate and cost-effective.