Question / Intervention Goal / Objectives
EmpiRx Health’s approach to managing pharmacy benefits applies stringent evidence-based clinical care, concierge service, and proactive oversight. EmpiRx Health employs a risk-bearing model and assumes accountability to lower pharmacy costs while improving health. Its pharmacists monitor prescriptions and contact prescribers when there is an alternative medication that has equal effectiveness, better safety, and lower price for the patients and payors. EmpiRx Health proactively manages members’ clinical care using an evidence-based approach backed by real-time data analysis. This approach strives to achieve a lower cost trend by following clinical care guidelines more closely than traditional pharmacy benefit management and by having pharmacists work directly with physicians.
Method / Calculation
For a 6,000-member group, the analysis calculated the per member per month (PMPM) cost for one baseline year and two post implementation years. The PMPM costs included the dispensing and administration fees and were net of discount for all three years shown. The baseline year had no catastrophic claimants and no claimants were excluded from the two post implementation years for having catastrophic costs.
Findings / Metric / Outcome / Savings
The PMPM cost in 2016 was $87.24; in 2017, $83.26; in 2018, $89.39. This represents a 2.5% increase over the three-year period where most PBMs were trending in high single digits or double digits year over year. Over the three-year period, the frequency of generic drug prescriptions went up 4.9% (generic dispensing rate); the non-specialty ingredient cost went down 1.8% per claim; and the specialty drug ingredient cost went down 1% per claim.
This assessment did not include rebates.