Reducing Plan Sponsor and Member Pharmacy Costs

For the past 4+ years, employer spending has increased approximately [20 percent] of total health care budget on pharmacy benefits. As pharmacy costs continue to increase, this figure could approach [25%] by year 2021.


If not managed effectively, prescription drugs costs could jeopardize the entire health care benefits program and cause a financial drain on a company resources as well as undermine profitability and long-term financial goals. Contributing factors include:

  • High cost generics

  • Formulation changes and dosage forms

  • Extended release formulations

  • Combination products

  • New high cost brands and market entrants

  • Inflation on existing products

Goal:

To address the above problem, employers need [seek] a solution that will provide guaranteed plan and member pharmacy cost savings while also maintaining or improving quality of care and that works with the existing PBM or TPA.

Methods:

The Right Rx Pharmacy Care Management Program offers an independent, unbiased review of prescription medications by engaging physicians and members directly to ensure that the best possible drug therapies are chosen, based on their clinical effectiveness and overall cost to patients and the plan. In most cases, this program will help not only the plan, but the members reduce their out-of-pocket costs for prescription medications.

Conclusion:

SOLUTIONS TO CONSIDER AROUND PRESCRIPTION BENEFIT

  • Right Rx is an independent, unbiased third-party clinical firm comprised of physicians and pharmacists

  • Clinical team ensures the best drug therapies are chosen based on Clinical effectiveness and overall cost to plan sponsor

  • Evidence-based clinical management approach proven to reduce costs and improve health outcomes

  • Separation of dispensing from PBM/prior authorization functions

  • Outreach made at physician level, then member/pharmacy upon physician acceptance

BACKGROUND:

Over the last 20 years, RightRx program has produced significant savings in drug expenditures for self-funded employers and health insurance plans covering more than 4 million lives throughout the U.S.


SAVINGS ESTIMATE


PLAN SPONSOR AND PLAN PARTICIPANT QUESTIONS

How does RightRx work?

  • RightRx has developed proprietary technology to review a client’s claims data and recommend possible drug alternatives to the prescribing physician

  • An automated care management system is used to assess the prescriptions being written and identify appropriate therapeutic alternatives

  • Recommended prescription modifications are communicated to physicians. If approved by the prescribing physician, new prescriptions are issued


How are savings derived?

Education shifting prescribing from high cost to lower cost equivalents:

  • Brand to brand therapeutic alternatives

  • Brand to generic therapeutic alternatives

  • Generic to generic therapeutic alternatives

  • Generic to brand therapeutic alternatives

One great feature of the RightRx program is that the savings are immediate and easy to measure. Savings occur when a member taking a targeted drug switches to a lower cost, clinically appropriate alternative. Only when the lower cost alternative is dispensed, are the savings calculated.


What are the benefits of RightRx?

The benefits include:

  • Expert, independent clinical oversight

  • Conformance to established guidelines and best practices

  • Plan and copay savings

For Plan Participants

How am I notified if my prescription is changed?

  • Once your physician approves the new prescription, RIghtRx will contact you by phone to make you aware of your doctor approved alternative

  • RightRx will attempt to reach you by phone 3 times, between the hours of noon to 9 pm EDT, Monday through Friday

  • After 3 attempts, RightRx will send you a letter

  • If RightRx does not hear back from you after 10 days after sending you a letter, a new prescription for the alternative will be forwarded to the same pharmacy that filled your previous prescription, so you can take advantage of the lower cost option and touch base with your doctor if desired

What if I don’t want to take the new prescription/want to go back to my original prescription?

Then you simply contact your physician and let them know that you want to stay on the original prescription.

How can I contact RightRx? Please feel free to contact a RIghtRx representative at 800-241-8440 if you have any questions or wish to proactively explore potential quality improvement or cost saving alternatives for any medications prescribed by your doctor.

Why Does RightRx Have Access to My Private Medical Information?

The RightRx Pharmacy Care Management Program works in concert with your PBM. The program is designed specifically to enhance your pharmacy plan and provide you with ways to improve your quality of care. In most cases, this program will help reduce your out-of-pocket costs for prescription medications too.


None of your private medical information is shared with your employer or any third party. Your private information is always maintained in strict confidence.


Why Would They Contact My Doctor Without My Permission?

The RightRx program was put in place by your employer to work in concert with your PBM managed benefit and to support the use of clinically equivalent drug therapies at reduced cost. Under the program, your prescribing physician is always contacted first to make sure they are comfortable with your making a switch from one medication to another. Only with the approval of your doctor will a RIghtRx representative contact you about an opportunity to take advantage of a lower cost therapy equivalent.


CONCLUSION:

The Right Rx program, typically targets an 8%-10%

reduction in client’s annual spend for prescription medications.

The Right Rx program savings are always incremental, above and beyond, any discounts or other cost savings provided through your PBM. Clients typically enjoy 100%-300% or greater returns on investment in the form of easily-measured, real dollar cost savings.

Plan beneficiaries typically save 30% or more in out-of-pocket costs, as well.

Arxcel

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