Uninterrupted Care.
Reduced Costs.

RxBenefits provided proactive clinical expertise and comprehensive solutions to address Infirmary Health’s challenges including:

340B Partnership: Maximized the use of the 340B drug pricing program to enhance in-house pharmacy utilization, driving down overall costs

Comprehensive Claims Review: Performed an in-depth review of claims to reduce unnecessary spending and improve medication management

Temporary Coverage Overrides: Ensured uninterrupted member service while transitioning Continuous Glucose Monitoring (CGM) devices from medical to pharmacy coverage

GLP-1 Strategies: Added extra scrutiny on all GLP-1 scripts and required prescribers to confirm medical necessity of each GLP-1 script, significantly reducing plan costs

The Impact

Infirmary Health and their benefits advisor worked with RxBenefits’ experts to control pharmacy spend without interruption to member care. The introduction of clinical management for GLP-1s led to a 54% reduction in plan costs, resulting in estimated annual savings of $5.7 million.

Members enjoyed a seamless transition for their CGM device coverage, enhanced access to cost effective medications, and 340B and Medication Therapy management (MTM) programs to better support their chronic conditions and provide essential medications at reduced costs.

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