The Situation
When a Southeast-based trucking company heard promises of substantial savings from a prescription benefit provider, they moved their $540K plan with more than 500 members to the new provider.
The promised savings depended on the company using patient assistance, but the new provider needed to do their homework. One employee taking an expensive drug called Tagrisso® couldn’t receive patient assistance because of their income level, and the trucking company was fully responsible for the high-cost therapy.
Sustainable solutions for controlling drug spending
RxBenefits Protect solutions are led by independent PharmDs, delivering clinical expertise, oversight, and intervention to ensure medications are appropriately prescribed and used while avoiding unnecessary, inefficient spending.
The Solution
With one member contributing such a high percentage of spend, the small company faced great financial risk. The self-funded employer turned to RxBenefits, a partner they could trust.
A claims review by our expert pharmacy team discovered ways to reduce the costs of Tagrisso®.
In addition to savings for the lung cancer treatment, they found that drugs meant to treat diabetes were being prescribed to their members for weight loss – a frequent off-label use of GLP-1 medications, like Ozempic®. These GLP-1 prescriptions were 22% of the plan’s total costs.
The Impact
The trucking company and their benefit advisor worked with RxBenefit’s experts to use actual member utilization data to create a program they can count on to deliver the best benefit with the lowest net cost. Using Protect, RxBenefits’ clinical management program, the plan will be guarded against wasteful pharmacy spending. The unique plan design now employs ExpressScripts’ SaveOnSP program, and the company will save $27K per year on Tagrisso®. Protect’s enhanced independent review process will automatically flag GLP-1 prescriptions to ensure they’re medically necessary, which saves the employer money and reserves the medications for those who need them.
