The Situation
A 37-year-old patient was prescribed Acthar gel for the management of Nephrotic syndrome. EmpiRx Health’s Population Health Management engine identified that this medication was not FDA approved for the condition. Upon review of the chart notes, it was identified that the patient had received treatment for 7 months with her previous insurance company and had no clinical response to treatment.

The Intervention
Our Clinical Pharmacist assessed the patient’s chart notes, and engaged the prescribing physician to discuss an alternate treatment, Rituxan, which has shown effectiveness in clinical studies.

Results Matter:
Patient’s symptoms resolved after first infusion cycle, allowing her return to work and her normal daily activities.

  • Original Prescription: Acthar HP gel 80U/ml @ $87,000 per dose
  • Clinical Recommendation: Rituxan 1g @ $10,000 per dose
  • Clinical Savings: $482,000 annual plan savings from this single clinical intervention