Outcomes

US-Rx Care’s proprietary clinical management programs have stood the test of time. 

Over $200 million in annual client savings on pharmacy benefit spend and 30%-50% improvements across multiple HEDIS/Stars measures.

US-Rx Care has become an indispensable to assist self-insured employers and health plans above and beyond any programs and services offered through their PBM or any other resource.

Health Plan Cost Reductions and Rebate Optimization

Health Plan A

An at risk medical group serving 10,000 patients in Medicare HMOs, 10,000 in commercial HMOs, and 10,200 in Medicaid was consistently over budget on their pharmacy capitation PMPM. The individual doctor offices have been able to decrease their pharmacy cost significantly using the US-Rx Care program. Combined aggregate savings to date are just under $3.0mm per year.

Health Plan B

A Medicare HMO with 30,000 lives and a zero copay benefit design reached out to US-Rx Care to trim their high per member per month cost for prescription medications. The plan licensed US-Rx Care’s Right Rx risk management program, which they implement with a small team. In the first 15 months of program implementation, the plan saved over $1.3 million of a total savings target of $4-$5 million annually.

Independent Practice Association

The IPA saved over $20 pmpm in drug costs within the first six months of program implementation (greater than 30% cost reduction).

Health Plan C

A regional Medicare Part D plan with 55,000 covered members implemented US-Rx Care’s Right Rx non-specialty Rx management program.  After 2 years on the program, the plan is savings over $4mm in annual drug spend.

Health Plan HEDIS/STARS Rating Improvements

  • 5 stars ratings raised to 4.5 and 5 stars across multiple measures
  • 500% increase in DEXA scan orders
  • Over 36% of members obtaining DMARD Rx within 60 days of diagnosis
  • Adherence Measures:
    • Diabetes (D12) YOY increase: 94% to 96%*
    • HTN (D13) YOY increase: 90% to 96%*
    • Statins (D14): YOY increase 88% to 95%*
    • 75% of members in adherence measure filling 90 day supplies within 6 months

US-Rx Care Full-Service Fiduciary Pharmacy Risk Management Examples

Right Rx Specialty Rx Savings Examples

Case Example 1: $93,000 savings to the plan

RD is a 170LB, 54-year-old white male diagnosed with moderate plaque psoriasis. MD ordered Cosentyx ($145K/year one).

US-Rx recommended submission of progress notes documenting the trial and failure of standard therapies for psoriasis (topical therapies, phototherapy, methotrexate, cyclosporine, Soriatane, Enbrel and Humira). RD failed on all the therapies except for TNF inhibitors. US-Rx recommend a trial of Humira ($52K/year), for a savings of $93,000 in the first year.

Case Example 2: $68,100 savings to the plan

KP is 160LB, 61-year-old white female diagnosed with Hepatitis C genotype 1a. MD ordered a 12-week treatment of Harvoni ($94,500).

The medical records revealed that KP was correctly diagnosed with Hepatitis C genotype 1a. KP was treatment-naive without cirrhosis with a pretreatment HCV RNA of less than 6 million units/mL, with metavir score of F3. US-Rx agreed that the treatment should include direct-acting antiviral oral therapy as requested by MD, however, US-Rx recommended Mavyret for 8-week treatment ($26,400) for a savings of $68,100.

Case Example 3: $33,850 savings to the plan

JS is a 15-year-old white male diagnosed with severe atopic dermatitis. MD ordered Dupixent ($34,150/year).

JS has failed topical therapies and light therapy. Dupixent is FDA indicated for moderate to severe atopic dermatitis only in adult patients. Since JS has not tried other systemic therapy (cyclosporine, methotrexate, mycophenolate, azathioprine), US-Rx has recommended a trial of one of the systemic agents. MD has agreed to a trial of methotrexate ($300/year) for a savings of $33,850.

Case Example 4: $541,245 savings to the plan

JS is a 45-year-old female, she was ordered Acthar Gel 80U SQ daily for 2 weeks for acute exacerbation of Multiple Sclerosis.

US Rx Care recommended a trial of high-dose corticosteroids administered intravenously (IV), methylprednisolone 500 to 1,000 mg IV daily for three to five days and or high-dose oral corticosteroids. The MD considered using home health services to administer methylprednisolone 500mg IV daily for 3 days followed by 160mg daily for 5 days followed by 64mg every other day for 20 days. Acthar Cost $542,305 for 2 week treatment. Methylprednisolone 500mg IV cost of $300 + Nursing Administration $360 + oral methylprednisolone $400 for a total of $1060. Savings of $541,245 per treatment.

Case Example 5: $38,321 savings to the plan

JO is a 61 year old male diagnosed with Psoriasis who had failed on Taclonex, Lidex and Dovonex creams. MD ordered Humira 40mg ($39,180) dosed once every other week.

US-Rx recommended a treatment trial with Methotrexate, if the patient tests negative for tuberculosis. The patient’s tuberculosis test was negative, and MD agreed to a trial of methotrexate. The Psoriasis responded well to methotrexate ($859) and topical corticosteroids.

Right Rx Non-Specialty Rx Savings Examples

m

Example 1

41,500 life employer Coalition
$3.5mm in annual savings

m

Example 4

44,500 life multi-state hospital system
$6.3mm in savings

m

Example 2

12,100 life school district
$4.7mm in savings

m

Example 5

2,200 life food products manufacturer
$950,000 in savings

m

Example 3

13,500 life healthcare system
$6.1mm in savings

Subscribe for the latest & greatest in pharmacy benefit risk management.

Thanks! You'll receive a monthly recap of all our new articles!