Mail and Specialty Rx Solutions Save City 220K+

Background

A municipality with nearly 1,700 covered lives aimed to achieve even greater cost savings than it already had with Prior Authorization, Step Therapy, and Quantity Limit programs in place for its members.

Action Taken

At Serve You Rx’s recommendation, the plan sponsor implemented the CAAP Rx® and Exclusive Mail programs. CAAP Rx is a copay assistance and accumulator management solution that lowers the amount the plan pays for specialty drug prescriptions by dynamically adjusting the member cost share amount to take full advantage of the assistance offered by drug manufacturers. The adjusted amount is accounted for via accumulator management. CAAP Rx dynamically sets member cost share by drug for each dispense, based on dose, frequency of administration, and available manufacturer financial assistance. The result is continued affordability for the member, promotion of adherence to therapy, and maximum plan savings.

Results

In the first seven months of the new plan year, CAAP Rx saved the client over $164,200, a 30.15% reduction in spend on eligible specialty claims. This equated to a savings of $12.36 per member per month (PMPM), without disrupting member access or benefits. Additionally, Exclusive Mail saved the client over $59,700 in the first seven months, a 12.40% reduction in spend. This resulted in an additional savings of $3.60 PMPM.

Contact us to learn more about mail and specialty Rx solutions that can help contain your pharmacy benefit program costs.
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