RX Advocates:

From High Cost to Free of Charge

1 Member

Identified for high-cost drug management and alternative sourcing

1 RX

Filled free of charge through a Manufacturer’s Assistance Program

No Disruption

No missed medications, thanks to our Patient Assistant Program

The Situation

One of our clients is a small, self-funded organization with fewer than 30 employees. During the annual plan renewal, their stop-loss carrier identified a member who was recently diagnosed with an orphan condition that required a maintenance medication costing $300,000 annually.

Based on this staggering amount, few stop-loss carriers were willing to quote their business, and if they did, they provided lasers on the high-cost medication.

With this feedback, the company began to strongly consider returning to a fully-insured plan. They decided to meet with their broker and Crumdale Specialty to discuss potential solutions.

Crumdale implemented a program that allowed the employer to alternatively source high-cost specialty drugs at substantially reduced costs.

Goals

CLIENT:

The client asked their broker to help find a way to reduce the high costs of the newly identified orphan medication.

BROKER:

The broker worked with Crumdale to develop and implement a specialty Rx cost-containment strategy to lower the drug’s costs for the client.

The Results

By proposing a new PBM and stop-loss vendor through Transformation Rx, we were able to identify an alternative sourcing solution and provide the high-cost medication free of charge to the member and at an 80% discount for the employer.

Pricing

FAVORABLE DISCOUNTS, TERMS, AND CONDITIONS

Stability

DECREASE RENEWAL VOLATILITY