County Health Plan Leverages Multiple WellDyneRx Clinical Programs to Reduce Drug Spend and Improve Patient Outcomes

SITUATION
WellDyneRx helped the plan save $9M within the first year
Despite implementing formulary and clinical programs with a competitive PBM, a large county plan was unable to control their drug spend. WellDyneRx clinicians performed an audit and realized that the county’s previous PBM was not following through on the trend management programs they designed to reign in drug costs. Within the first year of transferring their plan to WellDyneRx, the county saved over $9M, as verified by a third party consultant. While this significant cost reduction is noteworthy, the county was particularly impressed because WellDyneRx achieved these savings by simply executing on the previous PBM’s programs accurately and efficiently. The county, impressed with WellDyneRx’s attention to detail, subsequently decided to implement additional utilization management (UM) strategies and programs to help control costs.

SOLUTION
The county implemented multiple clinical and utilization management programs
WellDyneRx continuously reviews the county’s claims and recommends appropriate programs to reduce their drug spend while ensuring their members have access to quality care. The plan is currently using the Clinical Focus Formulary, which includes Prior Authorizations, Quantity Limits, and Compound Management tools. They also subscribe to WellManaged – Generics, WellManaged – Opioids, and Intercept, a patented program designed to mitigate specialty drug spend.

RESULTS
The plan significantly reduced drug spend
In 2017, the county leveraged the Clinical Focus Formulary and its standard utilization management programs to demonstrate overall savings and cost avoidance of $10.83 PMPM via the following:

  • Prior Authorization savings of $4.68 PMPM
  • Quantity Limit savings of $0.61 PMPM
  • WellManaged – Generics cost-avoidance of $5.54 PMPM

WellManaged – Generics, designed to increase generic utilization, increased the average Generic Dispensing Rate (GDR) from the baseline by 4%. Historically, a 1% increase in generic utilization translates into a 4% decrease in overall treatment costs. Since implementing Intercept in 2016, the plan achieved – and continually maintains – a 48% lower specialty trend than nationally reported values. In 2017, the county realized additional savings of $4.67 PMPM despite having an increase in specialty utilization and increases in AWP from drug manufacturers. The plan continues to experience a negative unit cost specialty trend.

The Compound Management program was implemented by the county in 2015 and reduced their compound trend PMPM by 77%. The total number of compound claims decreased by 84% and the number of requests for medical exceptions for compounds decreased 47% from the previous year. Physicians appreciate that there are more clinically appropriate and cost-effective FDA-approved options than compounded products, as evidenced by the significant decrease in prescribing patterns.

WellManaged – Opioids, implemented by the county in 2017 to curb opioid abuse, is already making a significant impact on the plan. Since implementing the program, the county has observed an:

  • 11% reduction in Morphine Equivalent Doses (MEDs)
  • 15% reduction in chronic opioid users
  • 12% reduction in the average monthly number of opioid users
  • 56% reduction in opioid PMPM ($0.54 PMPM savings)

THE BOTTOM LINE
We offer custom programs to suit our client’s unique needs
WellDyneRx’s team of clinicians consistently evaluate and monitor the marketplace to develop and provide the most cost-effective and clinically appropriate clinical programs and utilization management strategies for our clients.

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