The Cost of Carving-In: One Client's Journey
Case Study
The RxBenefits Solution
A Plan Rooted in Oversight
Discover how RxBenefits can optimize your pharmacy benefits plan while protecting member outcomes. Contact us today!
Bundling medical and pharmacy benefits by carving in pushes pharmacy benefits – and oversight of it – to the back burner. That might make sense for the integrated carrier because medical benefits are a bigger piece of the pie.
But it doesn’t serve the client. Without a laser focus on pharmacy spend, including independent clinical management and expert strategies to curb specialty costs, clients miss meaningful opportunities to save money, improve outcomes, and take better care of their members.
As a pharmacy benefits optimizer RxBenefits leverages special, focused expertise that enables clients to balance their plan’s unique member care and cost management goals for strategic success and sustainable savings. With every drug dollar on the line, employers can’t afford the waste that comes with carving in.
A Compelling Offer
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Jack Dixon,
CEO, Company Name
A leading home healthcare provider took a chance that didn’t pay off. After five years with RxBenefits, they moved to an integrated carrier, enticed by the allure of lower fees and streamlined administration. At the time, their per-member-per-month (PMPM) cost was $60.25, with specialty medications accounting for 37% of their total pharmacy spend.
At a glance
Strategic Savings. Sustainable Success.
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Decrease in PMPM Cost
$23.96
Home Healthcare Provider
Members
1,600
Reduction in Specialty-Attributed Spend
13.6%
Within the first 18 months, their PMPM skyrocketed to $90.21 – a nearly 50% increase. With high-dollar claims for conditions like cancer and chronic inflammation dominating their spend – and a lack of devoted resources to evaluate these claims due to the integrated model – specialty medications now accounted for 58.3% of overall spend.
A Reality Check
In a carved-in strategy with an integrated carrier, pharmacy represents a fraction of the total benefits plan spend and is, therefore, not an area of focus. With RxBenefits, it’s our sole focus.
Our dedicated team of independent, clinical pharmacists jumped in to course-correct by:
Recommending clinically equivalent, lower-cost alternative medications without compromising member care.
Leveraging manufacturer copay assistance to reduce costs for both the plan sponsor and its members
Results That Matter
The impact of returning to RxBenefits was immediate and measurable:
PMPM fell from $90.21 to $66.41 within the first quarter.
Specialty medication spend dropped by nearly 15%.
Members benefitted from clinically equivalent treatment.
Transition was seamless, with ongoing client support.