The Situation:
A mid-50s male with hyperlipidemia (high cholesterol) was prescribed Fenofibrate 120mg tablets. Various new generic formulations may come at a higher cost than a conventional formulation of a generic medication, with no significant clinical advantage. In this instance, 120mg is a high-cost, low-value formulation of this generic medication, and—contrary to its perception as a lower-dose formulation—offers no significant clinical difference from the conventional 145mg formulation. Our population health management engine identified this case as an opportunity to optimize treatment, and a clinical pharmacist was engaged.

The Intervention:
After identifying that the 145mg dose would be clinically appropriate for the patient’s condition and would eliminate wasteful spend associated with the higher-cost formulation, our pharmacist shared this recommendation with the patient’s prescriber. The prescriber agreed, and the switch was made.

Results Matter:
By optimizing the patient’s cholesterol regimen, our pharmacist was able to eliminate wasteful spend without compromising care:

  • Original Prescription: Fenofibrate 120mg, 1 tablet daily
  • Clinical Recommendation: Fenofibrate 145mg, 1 tablet daily
  • Clinical Savings: $5,358

Of course, this was only a single intervention—one of many through which EmpiRx Health provided healthcare value on behalf of this client. Overall, EmpiRx Health delivered a tailored savings strategy, inclusive of pharmacist-led clinical interventions, that drove a 46% decrease in plan per member per month (PMPM) spend compared to the client’s prior PBM.

The Takeaway:
25% of healthcare is spend is waste; when we improve the quality of prescribing with a focus on clinical appropriateness, we add value back into the healthcare ecosystem. Pharmacists’ level of understanding drug interactions and the effectiveness of therapies is bar none, and that knowledge allows them to expertly advise healthcare professionals, and to play an integral role in delivering clinical care. By ensuring pharmacists are a vital part of multidisciplinary care teams, we can optimize patient health outcomes and achieve true value-based care.