This research was presented at the Academy of Managed Care Pharmacy (AMCP) 2020 virtual learning event April 20-24.
June 23, 2020
Prime Therapeutics uses Specialty Monitor™ to help Horizon Healthcare Services, Inc. identify more than $3.1M in drug cost savings
Industry-leading analytics solution, powered by the Artemetrx platform, informs near-term interventions designed to improve health outcomes and lower total cost of care.
Horizon Healthcare Services, Inc. (Horizon), New Jersey’s largest health insurer, recently published research findings on its commercial members most at risk for experiencing high drug costs. Using actionable data gathered from the Specialty Monitor™ solution provided by Prime Therapeutics, Horizon identified 100 high-cost members and categorized them by trends driving high costs, such as medication overuse, incorrect billing or use of a higher-cost site of service when an equally safe, lower-cost option is available. Horizon pharmacists implemented interventions to mitigate the financial impact of these cost drivers and improve members’ care and tracked their effectiveness for one year. The study showed that during this timeframe, intervention savings totaled $3.1 million.
More than one-third of the 100 members in the study group received high-cost specialty drugs. Less than 2% of Americans receive specialty medications for complex and rare conditions, but net spending in this category of drugs has increased as a percentage of total drug spending from 24.7% in 2008 to 46.5% in 2017. With a growing number of high-cost therapies for complex conditions in the drug approval pipeline, there’s a need for Horizon to predict high costs before they occur.
“We know pharmacist-led interventions have been shown to help reduce costs and increase appropriate drug utilization,” said Saira Jan, Pharm.D, M.S., vice president and chief pharmacy officer for Horizon. “Specialty Monitor automates what was once a painstaking process, to help us predict the financial impact of the use and administration of high-cost specialty drugs. Due to the rising cost of medications, frequent monitoring of high-cost members within a managed care organization is crucial.”
“We’re excited to offer this industry-leading tool to Blue Plans to further extend their specialty drug management capabilities,” said Steven Johnson, vice president, health outcomes for Prime. “Specialty Monitor is one vital piece of our total drug management strategy. It gives Blue Plans a comprehensive breakdown of medical and pharmacy claims in a streamlined way and provides predictability that allows them to intervene quickly to reverse wasteful and inappropriate drug spend patterns.”
Specialty Monitor is Prime’s state-of-the-art, total drug management tool leveraging the industry-leading Artemetrx data and analytics platform. It aggregates specialty medical and pharmacy claims data to identify patterns of high-cost drug use, cost and waste in the health care delivery chain. The tool compares the cost of different care settings, like outpatient hospital and physician office, to illustrate which channel is used most often and where opportunities exist to shift to a lower-cost setting while still upholding member safety and convenience. Prime leads the industry as the only pharmacy benefit manager (PBM) offering invaluable insights in the form of comprehensive benefits data that can be filtered and reported in a myriad of ways to suit payer needs.
About Prime Therapeutics
Prime Therapeutics LLC (Prime) makes health care work better by helping people get the medicine they need to feel better and live well. Prime provides total drug management solutions for health plans, employers, and government programs including Medicare and Medicaid. The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 30 million people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.
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