The right meds at the best value

A Univera Healthcare program is focusing on medication safety while saving millions of dollars in prescription drug costs. The program, Pharmacy Concierge, is available to most midsize and large employers through the health plan.

“Improving care is the primary goal of Pharmacy Concierge,” says Mona Chitre, PharmD, chief pharmacy officer and president of pharmacy solutions at Univera Healthcare. “Slowing the growth in drug spending without compromising care is an added benefit.”

With Pharmacy Concierge, a team of clinical pharmacists from Univera Healthcare reviews an employer’s benefit plan’s pharmacy claims for opportunities to improve patient care and/or reduce pharmacy spending. This includes finding unnecessary or inappropriate medications, incorrect dosing, safety concerns, and savings opportunities with approved generics or biosimilars. Generics and biosimilars are as safe and effective as their brand name counterparts but can cost less.

Last year, the team eliminated $11 million in unnecessary or inappropriate pharmacy spending. Nearly 900 employers participated, and more than 7.4 million claims were reviewed for potential clinical safety and/or savings opportunities.

Here are some examples:

• Pharmacy Concierge identified a member who had been prescribed two different medications to treat their diabetes. When used at the same time, the medications have no added benefit according to American Diabetes Association guidelines. In addition, one of the medications is associated with potential safety concerns. Outreach was made to the prescribing physician, who worked with the member to adjust the prescription therapy.
• The program identified a member who was prescribed the incorrect dosage of an anti-depressant. The physician was notified of the dosing issue. A lower cost generic alternative was also suggested. The member is now taking the correct and safer dosage, with an annual out-of-pocket savings of $3,500.
• A consortium of upstate New York school districts reduced pharmacy spending by more than $1 million after participating in the program.

“All medication decisions are made by the member’s provider in consultation with their patient,” says Chitre.

In the first six months of 2023, the clinical pharmacists have identified $10.8 million in unnecessary or inappropriate pharmacy costs.

To learn more about Pharmacy Concierge, visit univeraforbusiness.com.