The Challenge
When undergoing our Complex Condition Intervention (CCI) review process, the hotel franchise found they had a member whose medication cost over $12,000 a month due to unoptimized dosages.
CCI provides additional oversight for high-cost specialty drugs. In addition to the standard High Dollar Clinical Review, our PharmDs consult with a condition specialist to ensure the prescription is for the right drug, in the right dose, at the best possible price.
The Solution
As part of CCI, the RxBenefits clinical team identified that the hotel franchise’s member was using Imbruvica. which is cheaper in capsule form than in tablet form (something many prescribers don’t know). By adjusting the prescription to a different method — from one 280mg Imbruvica tablet per day to two 140mg Imbruvica capsules per day — the hotel saved thousands of dollars a month without changing the member’s medication.
Think About It This Way
Imagine you wanted room service; a small order of fries costs $2, and a large order costs $5. If two small orders offered the same amount of fries as one large order, you’d probably get two small fries and save money.
The Impact
This simple switch resulted in savings of almost $5K per month without any member disruption. If the member stays on this medication, the annualized savings to the plan will be over $58K.
$5K Monthly Savings (40%)
0 Member Disruption
$58K Annualized Savings
