Clinically-Driven

EmpiRx Health is transforming the PBM industry by putting the pharmacist at the center of a clinically-driven, customer-first pharmacy care model. Our clinical pharmacists use AI-powered population health analytics to coordinate the best patient care, producing better plan performance and customer results and optimizing member health outcomes. It’s a transformative PBM operating model that literally puts the pharmacist back in the center of pharmacy benefits management.

The EmpiRx Health clinically-driven PBM model holistically evaluates patients healthcare needs based on their own unique needs and risk factors. The pharmacist collaborates peer-to-peer with the patient’s prescribing physician to suggest clinically-appropriate changes to their drug therapies. This usually involves recommending lower-cost medications or dosing and regimen changes and optimizations.

EmpiRx Health’s clinically-driven pharmacy care model emphasizes value over volume. Unlike other PBMs, our pharmacy care approach does not rely on a restrictive formulary or reduced medication access to maximize rebates and drive inappropriate utilization of high-cost therapies. The EmpiRx Health clinically-driven PBM model relies on pharmacists collaborating with physicians and practitioners to produce the optimal drug mix that optimizes health outcomes while reducing costs.

During the past year, there has been a lot of buzz about biosimilars as lower-cost alternatives to biologic drugs. Biosimilars are biologic medications that are highly similar to drugs already approved by the FDA. They are used for treating the same conditions and have the same mechanism of action as the reference, or originator, products. Through clinical trials, biosimilars have been proven to be just as safe and effective as their reference biologic drugs, meeting the same quality standards.

There is a growing expectation that biosimilars will transform the specialty drug landscape just like generic drugs did for traditional medications. They can increase access to important therapies and improve patient outcomes, all while providing a lower-cost option for patients.

As the leading clinically-driven PBM company, EmpiRx Health has been an early adopter of biosimilars. Why? Because biosimilars offer the same level of safety and effectiveness as the original products, but at a lower cost – sometimes substantially lower. In fact, EmpiRx Health was one of the first PBMs that started to prefer lower cost biosimilars to original products.

In early 2023, EmpiRx Health was the only PBM that decided to prefer the lower cost Humira biosimilars in its formularies. Prior to making this decision, EmpiRx Health’s pharmacy experts performed a thorough review of available clinical data, dosing and formulation options, and other critical factors impacting member experience. Following that comprehensive review and analysis, we decided to select two of the lowest priced Humira biosimilars for our formulary.

This Humira formulary decision was consistent with our clinically-driven, customer-first pharmacy care approach, which puts the pharmacist at the center of the care model. When you put the pharmacist back in pharmacy benefits management, everyone wins.

It’s no secret that prescription drugs have become an increasingly large part of every dollar spent on healthcare. But only 1-2% of a patient population is driving around half of total prescription spending. That high level of drug spending is largely driven by patients utilizing specialty medications.
Specialty cost trends are increasing at a significantly higher rate than for traditional or non-specialty medications. Over the last few years, most new drugs approved by the FDA have been specialty. The drug pipeline is still predominantly focused on specialty medications. In the past year, there have been 55 specialty medications approved by the FDA. And there are almost 50 specialty medications already slated for FDA decisions in 2024.

The seemingly non-stop growth in specialty drug launches and the associated exploding costs put enormous pressure on plan sponsors and their members, who are also seeing rising premiums, higher deductibles, and growing copays or coinsurance.

EmpiRx Health’s value-based, clinically-driven pharmacy care model is made for the specialty drug challenge. Intimately involved with every client, our expert clinical pharmacists use the most sophisticated population health technologies to identify opportunities to mitigate the soaring costs of specialty drugs.

Here’s how: Our pharmacists collaborate peer-to-peer with the patient’s prescribing physician to suggest clinically-appropriate changes to their drug therapies. This involves recommending lower-cost medications or dosing and regimen optimizations.

This pharmacist-centric care model emphasizes value over volume. It doesn’t rely on a restrictive formulary or reduce medication access to maximize rebates and drive inappropriate utilization of high-cost therapies. The EmpiRx Health clinically-driven pharmacy care approach relies on pharmacists collaborating with physicians and practitioners to drive to the most appropriate and cost-effective drug mix that optimizes the health outcomes of members/patients.

EVIDENCE-BASED MEDICINE OPTIMIZES CARE

Patient: 64-year-old male
Diagnosis: Advanced Prostate Cancer
Population Health Management Engine Identified: High-cost specialty medication

• Our Clinical Pharmacist reviewed the request for Nubeqa (300mg tablets, 2 tablets by mouth daily) and contacted the physician to discuss a treatment plan.
• Chart notes indicated the patient had a good response to Abiraterone.
• The physician agreed with our recommendation for the patient to continue Abiraterone.
• New Therapy: Abiraterone 250mg tablets, 4 tablets by mouth daily
• $64,095 Annual Plan Savings achieved

CLINICALLY APPROPRIATE ALTERNATIVE OPTIMIZES WASTE

Patient: 42-year-old female
Diagnosis: Rheumatoid Arthritis
Population Health Management Engine Identified: High-cost specialty medication

• Lower-cost alternatives are an essential component to optimizing therapy
• Our Clinical Pharmacist reached out to the prescriber to discuss the patient’s mild rheumatoid arthritis.
• The patient would benefit from a nonbiologic DMARD therapy as a first-line versus a biologic, and the prescriber agreed.
• New Therapy: Sulfasalazine 500mg, 2 tablets by mouth twice daily
• $24,590 Annual Plan Savings achieved