Effective October 1, 2018: Enhanced Utilization Management
WellDyneRx is continually evaluating our formularies to ensure that clinically effective therapies are offered at the most affordable cost. We’ve seen unprecedented focus on rising pharmacy costs in the last few years, primarily driven by a robust specialty pipeline and egregious pricing behavior by some manufacturers. This pressure places the pharmacy benefit foremost in the minds of our clients and members. We take these concerns very seriously and are proud of our current strategy which maintained drug trend in 2017 at only 1.2%.
Effective October 1, 2018*, WellDyneRx will implement utilization management enhancements to steer members toward more affordable medications. These include:
- WellManaged – Generics
- WellManaged – Preferred Brands
- WellManaged – Hyperinflationary Drugs
In an effort to minimize member disruptions, this initiative will launch on October 1, 2018 with a “pay and educate” period. This will allow plan participants to continue filling their prescriptions at their current co-share through the end of the year.
Effective January 1, 2019, clients may choose to:
- Extend a “pay and educate” period to all existing users and only allow us to influence new users. You may extend the “pay and educate” period to existing users for a defined period of time, for example 90 days, or without a term date.
- Allow us to influence all utilizers, which will generate savings.
If you decide to opt out of any of these utilization management enhancements, please advise us by September 30, 2018.
WellDyneRx will also send notifications to affected individuals at least six weeks prior to January 1, 2019 to let them know that the “pay and educate” period will end on December 31, 2018. These letters will encourage members to speak to their prescribers about covered medications and obtain new prescriptions prior to January 1, 2019. We have provided a brief summary of each of our October 1, 2018 utilization management enhancements below:
- WellManaged – Generics works with a plan’s formulary to drive utilization of clinically proven and cost-effective generic drug products. By encouraging members to try a preferred generic over a higher cost generic, often manufactured with the same active ingredient(s), or a higher cost brand, drug spend is reduced without compromising quality of care.
- WellManaged – Preferred Brands focuses on top therapeutic categories that offer a wide variety of safe and effective treatment options. Before trying a second-line agent in the same medication class, members are encouraged to use less expensive, clinically equivalent options first.
- WellManaged – Hyperinflationary Drugs monitors the pricing and clinical relevance of new and existing medications. Drugs are added to the prior authorization exception list based on a variety of cost-related factors. Historical data demonstrates that most WellDyneRx clients spend approximately 2% of their total drug spend on hyperinflationary medications. This initiative can generate savings of $1.00 PMPM.
WellManaged – Clinical Programs are also available to ensure patient safety, boost adherence rates, and promote quality outcomes for chronic conditions like diabetes, asthma and hepatitis C – as well as appropriate use of opioid pain relievers. As we develop programs for other conditions, we will automatically introduce them into this suite of WellManaged – Clinical Programs. For more information about these important programs, please reach out to your Account Executive or visit our clinical expertise webpage.
Our hope is that this strategy will improve the health and well-being of your plan participants while allowing you to provide an employer-sponsored benefit that ensures high quality care while containing costs. At WellDyneRx, we believe that every little thing brings big outcomes. We’re committed to improving financial and clinical outcomes for our clients and members by optimizing and enhancing every health plan, every prescription fill, and every interaction we have—no matter how small.
If you have questions or concerns, please contact your Account Executive.
* Note that Member Services representatives will not be able to provide copay quotes for alternative medications until January 1, 2019.
2018 Quarter Three WellInformed Table Contents