Total drug management can be difficult to execute when measures aren’t taken to manage spend consistently across benefits. Drugs that are administered in doctor’s offices, clinics or through home infusion — a high percentage of which are specialty drugs — should be managed just as carefully as drugs covered under the pharmacy benefit.
The drug landscape is changing too rapidly for plans to get bogged down by fragmented drug management practices. Health plans need to implement a single, integrated strategy if they want to keep up and avoid waste.
Fragmented, disconnected drug management strategies can lead to wasted time and resources, missed opportunities and more work for Health Plans.
Click to explore some challenges of fragmentation.
Added Waste
Drug spend accounts for as much as 23% of total health care spend1 and when it is not managed consistently through integrated datasets and workflows, there is potential for significant waste. A number of challenges prevent plans from achieving integrated drug management:
Some plans still have not implemented any kind of medical drug management solution at all.
Missed Opportunities
Failing to apply a consistent, rigorous drug strategy to drugs billed under the medical benefit can be both costly and unsafe.
Fragmentation increases the risk of duplicate claims and overpayment within and across benefits.
More Work
Multiple systems, manual file management — or no systems at all
Many Health Plans use multiple systems or outdated processes, creating serious administrative challenges and wasting valuable time. A few still handle claims manually, physically moving files from one clinician’s desk to another. Some plans don’t manage medical drug spend at all, leaving them with serious cost, compliance and patient safety risks.
Doing things the way they’ve always been done is no longer a sustainable option.
In order to keep up with the rapidly evolving drug marketplace, plans need greater clinical expertise, more rebate negotiating power, and advanced systems and resources — all integrated into a centralized cross-benefit platform.
More high-cost drugs are coming to market, including biosimilars, gene and cell therapies.
Applying the right controls for medically billed drugs now is critically important.
Our Medical Drug Management suite offers a full spectrum of drug management solutions designed to fit a wide variety of plan needs. And while the most value is driven by a cross-benefit strategy, we can implement these solutions as either standalone medical or a cross-benefit arrangement.
We have found that most of our clients are best served by selecting one of our two most popular approaches — either a full-service approach with dedicated medical support teams and a contractually guaranteed 3:1 ROI, or a streamlined, self-service software approach that puts you in the driver’s seat.
Our Approach incorporates decades of deep clinical knowledge that drive powerful results across both pharmacy and medical benefits.
We lead the industry in managing pharmacy drug trend:
drug trend for plans three years in a row5
saved for plans by our specialty SafeGuardRx programs in 20186
We’ve delivered significant savings through our Comprehensive solution:
PMPY savings for commercial and $93.77 PMPY savings in Medicare lines of business respectively7
billed claims have required reconciliation actions by our program7
average savings for each case proactively redirected to a lower-cost site of care8
Answer these questions to see which recommended approach is better suited to your needs — or review our complete capabilities list and design a unique solution that is tailored to your specific goals.
Comprehensive Approach
Core Approach
Full Capabilities Index
