Discovery of Improper Prescribing results in positive outcome for Plan and Patient

ELMC RxSolutions was asked to review the case of a patient who requested a prescription for Humira from a provider. The patient had been treated with nonsteroidal anti-inflammatory drugs (NSAID) for Rheumatoid Arthritis but asked the physician to prescribe Humira instead. The patient did not follow the treatment guidelines and did not have either the required TB or Hepatitis screening performed. Once the proper testing was performed, it was determined that the Humira request was not appropriate for the condition and a more suitable drug was prescribed, saving the client in excess of $60,000 per year.

Helping Insurance Captive Manage Escalating High Cost Prescription Medications

An Insurance Captive approached ELMC Rx Solutions for help in managing continuously escalating high cost and specialty medication claims. The captive had done a commendable job in managing its medical claims cost and trend, but prescription drug costs were proving particularly challenging. After ninety days of working with our Clinical Pharmacy Team, the captive is experiencing saving of approximately 15 percent on its annual specialty drug spend based on procedures, criteria and protocols now in place to manage ongoing specialty costs and control trend.

Savings Generated by Eliminating Unnecessary Prescription

ELMC Rx was asked to review a case in which a physician had properly diagnosed a patient’s dyskinesias and tremors. A review of the physician’s chart notes determined that the condition was related to stress/anxiety. ELMC Rx’s Clinical Pharmacist recommended follow-up and treatment for the anxiety in lieu of the Apokyn, saving the plan $29,000 per month.

Large Labor Plan Struggles with High Cost of Prescription Drug Benefits

A Union Trust program of more than 20,000 members with an annual prescription drug spend of approximately $24 million was committed to providing its members with superior medical and prescription drug benefits. Unfortunately, the cost and utilization of specialty drugs had created a serious financial challenge to the plan. Since engaging ELMC RxSolutions, the Trust has experienced a savings of just under $3 million per year, equivalent to $26 in savings for each dollar invested in the monitoring program. The Trust also adopted contract provisions and annual strategic risk management programs that have resulted in additional ongoing savings to the program.