How This PBM Kept Costs Down While Utilization Went Up

In an interview with EBN, EmpiRx Health CEO Karthik Ganesh shares how a value-based PBM model successfully contained employer costs while meeting the increased demand for mental and behavioral drugs.

While most employers may equate higher use of medications to higher costs, it seems the latest study could prove them wrong.

EmpiRx Health, a pharmacy benefit manager, found that behavioral health-related medication drove an increase of nearly 10% in pharmacy claims for their clients. But while drug utilization for mental health needs rose in the last few years, employer costs did not. In fact, EmpiRx Health saw a nearly 5% drop in plan spend per utilizer — in other words, employers saved money despite employees seeking more pharmaceutical care.

“It comes down to our model,” says Karthik Ganesh, CEO of EmpiRx Health. “We are moving from higher-cost medications to clinically appropriate yet lower-cost medications. We are not allowing patients to be on multiple medications that work against each other. We are buying for value, not volume.”

Read the full article here.


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