Case Study Highlighting a Clinically Appropriate Alternative to Optimize Waste

Real value is achieved by focusing on whole-person health and clinical appropriateness. In this study, one patient case led to more than $48,000 in clinical savings while managing the patient’s quality of life on the new medication recommendation! You’ll see how our population health model drove over $4MM in savings and personalized patient care since client implementation.

Healthcare done right requires personalized care that improves health outcomes and delivers savings that impact our clients’ bottom line. We begin with a Population Health Management model tailored to your population, and then manage drug utilization to reduce waste and cost to your plan and members. EmpiRx Health’s Clinical Pharmacists work with doctors to prescribe the right medications for better health outcomes. Our open formulary provides access to all medications so that doctors can decide what’s best for a patient.

Optimized drug mix leads to better health outcomes. In this case study, you’ll see how the combination of driving to the lowest cost, unwavering clinical appropriateness, and member care proves that real value in healthcare is possible.

A 32-year-old female diagnosed with Hepatitis C who was prescribed Epclusa. Our population health management engine identified this case as a new specialty medication for this patient.

Specialty medications are the biggest driver of plan spend; therefore, our Care Management team reviews each patient case for clinical appropriateness. Clinical reviews include a check of other drug utilization, patient chart notes, and a 1:1 consultation with the prescriber. Our Clinical Pharmacist examined the patient’s whole health condition for the best medication and as an opportunity to eliminate “waste” in our client’s drug mix―unnecessary drug spend and inappropriate dispensing.

A review of the patient’s history showed no co-morbidities and no prior treatment for Hepatitis C. Our Clinical Pharmacist determined the availability of a lower-cost alternative that would appropriately treat the patient. Our Pharmacist contacted the prescriber to suggest a generic alternative at a significantly lower-cost than the expensive brand medication initially prescribed. The prescriber agreed that this lower-cost alternative was clinically appropriate for the patient.

EmpiRx Health proves that clinically appropriate alternatives optimize waste, even for complex conditions requiring specialty medications.

  • Original Prescription: Epclusa Tab 400-100 28/28, 1x per day
    Clinical Recommendation: Sofosbuvir/Velpatasvir tabs 400-100 mg 28/28, 1x per day
  • The patient’s Hepatitis C was well managed with the new medication recommendation.
  • Clinical Savings – $48K

As a result of success stories like this, EmpiRx Health drove over $4MM in deep sustainable savings since implementing this client on 1/1/20.

  • 42.5% of savings achieved through our clinical interventions on Specialty medications, proving that clinically appropriate therapeutic switches are possible in specialty Rx.
  • Despite an increase in 17% utilizers and 21% increase in utilization, the client experienced a -5.7% cost per claim over 2 years!

Appropriate clinical care, such as the intervention stated above, improves member health, and lowers partner costs. Our savings strategy tailored to our client’s unique population risk factors ensures a no “one size fits all” approach.


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