Situation:

A healthcare plan spent more than $1B annually on specialty drugs across medical and pharmacy benefits. 30% of these were for drugs available under both benefits. The plan had implemented several initiatives to control spend, but lacked insight into their effectiveness and an overall coordinated specialty drug strategic plan.

Approach:

AArete led the Rx team in the construction of a mechanism to drive financial, operational, and strategic improvements through the development of a Cost-of-Care Portfolio Management Process.

By adopting a disciplined approach to identifying, evaluating and prioritizing opportunities, the Rx team were able to effectively implement initiatives to drive down the cost of care, generate operational efficiencies and improve quality.

Results:

A 5-phase approach was initiated to guide the innovation process and solidify the specialty drug strategy around medical/Rx cost savings, operations improvement, quality management and vendor performance.

These initiatives drove 4.5% reduction in specialty costs focused on specific disease states, PA operations improvement, benefit channel optimization, preferred products and more.