Uninterrupted Care and Reduced Costs for Infirmary Health Members Delivered by RxBenefits
The Situation
Infirmary Health, a leading health system in Mobile, Alabama, faced significant challenges managing pharmacy benefits for 3,945 employees and 7,815 members.
Rising prescription drug costs, limited control over pharmacy spend, and concerns about member impact during benefit plan changes were critical issues. The broker recommended partnering with RxBenefits to empower the inhouse pharmacy with innovative cost-saving strategies and to implement a thorough review process of all available options to maximize both efficiency and profit for the hospital.
The Solution
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.
$5.7M
Estimated Annual Savings
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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