$5.8 Million in Savings... The Power of Independent Clinical Review
Case Study
By addressing a single inappropriate prescription, RxBenefits demonstrated its expertise in delivering immediate and substantial cost savings for the client.
Significant Impact of Addressing One Prescription
The Impact
The Results
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This outcome demonstrates the significant impact that independent clinical management can have on both cost savings and patient safety. By identifying and addressing an inappropriate high-cost prescription, RxBenefits saved their client nearly $6 million annually while ensuring the patient avoided potentially harmful side effects. This success highlights the importance of proactive, expert-driven pharmacy oversight in navigating the rising costs of specialty medications. With a focus on strategic savings and member well-being, RxBenefits provides clients with the tools and expertise needed to achieve sustainable success in today’s complex healthcare landscape.
The Solution (Click on a tab to learn more)
The Challenge
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Jack Dixon,
CEO, Company Name
One employee’s diagnosis of a rare disease resulted in a significant cost impact for a client with nearly 2,400 members. The member was prescribed Revcovi™, a high-cost medication used to treat a rare immunodeficiency condition – which raised the client’s overall cost by 50% in just three months. Despite the high cost, their pharmacy benefits manager’s (PBM’s) clinical management program did not flag the prescription for additional review.
$485,000
Monthly Savings
2,400
Members
$5.8M
Saved on a single inappropriate prescription
At a glance
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4,500
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4,500
Monthly Savings
$485,000
Strategic Savings. Sustainable Success.
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Collaboration with the Prescriber
Positive Outcomes for the Client and Patient
RxBenefits’ independent clinical pharmacist flagged a prescription as concerning due to its high cost, marking it for follow-up. When the PBM approved the same prescription for a second month, the pharmacist conducted an in-depth review, examining the diagnosis, detailed chart, and lab notes. This review unveiled a potential misdiagnosis, prompting the case to be referred to an independent third-party specialist, who confirmed the pharmacist’s concerns.
Upon confirmation, the RxBenefits pharmacist reached out to the prescriber to discuss the findings. The prescriber acknowledged that the patient was experiencing significant side effects and shared they were reevaluating the diagnosis and medication. This open communication allowed for careful consideration of the patient’s condition and treatment plan.
Based on this thorough evaluation, the pharmacist denied the prescription until a proper diagnosis and appropriate medication could be determined. This intervention not only saved the client a significant amount of money on an expensive and unnecessary prescription but also safeguarded the patient from potentially life-threatening adverse events by ensuring their treatment was clinically appropriate.
Identification of a Concerning Prescription
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Identification of a Concerning Prescription
Collaboration with the Prescriber
Positive Outcomes for the Client and Patient
Annual Savings
$5.8m
The Power of Independent Clinical Management
This achievement highlights the critical role independent clinical management plays in controlling rising pharmacy costs. Through targeted strategies, clients are better equipped to mitigate challenges associated with high-cost specialty medications.
A Strategic Approach to Sustainable Success
RxBenefits not only helps clients achieve impressive savings but also ensures a balance between financial well-being and member health. By proactively managing pharmacy benefits, organizations can achieve long-term success while protecting the well-being of their members.
