As a white-glove healthcare services partner, EmpiRx Health’s responsibility to our clients is to have their back, every step of the way. One way we do this is to help our clients drive total cost of care strategies that minimize costs.
A 56-year-old female patient with Paroxysmal Nocturnal Hemoglobinuria (a disease of the blood) was receiving Ultomiris IV Infusion every two months through her medical benefit at a significant cost to the plan. We investigated the options for medical benefit coverage against the pharmacy benefit and determined there was an opportunity to secure savings for our client.
We committed to covering the infusion therapy under the pharmacy plan and built a custom solution to ensure a smooth transition for the patient in an otherwise complex care process. Our team undertook a comprehensive clinical appropriateness review, and then coordinated across the patient, the doctor, and the infusion pharmacy to complete a successful, uninterrupted transition of therapy for the patient.
CLINICAL & FINANCIAL OUTCOME
Smooth transition of care from medical to pharmacy benefits with no gaps in therapy. Patient continues to receive clinically appropriate care and will be continuously monitored.
- Original Medical Benefit: Ultomiris 1,100 units, 3 vials/56 days, $129,023.88
- Clinical Recommended Pharmacy Benefit: Ultomiris 1,100 units, 3 vials/56 days, $69,740.06
- Clinical Savings: $384,094