Pharmacy Concierge eliminates $17 million in unnecessary spending at Univera Healthcare

Univera Healthcare’s Pharmacy Concierge program was initially designed to focus on improving member care. If the program slowed growth in drug spending, that would be an added benefit. The health plan’s metrics show the Upstate, N.Y.-based health plan is meeting both objectives three years in.

The Univera Healthcare Pharmacy Concierge team eliminated $17 million in unnecessary or inappropriate pharmacy spending for its midsize and large employers in 2024. More than 11 million claims were reviewed for potential clinical safety and/or savings opportunities from nearly 2,000 participating employers. The health plan’s clinical pharmacists have identified nearly $3 million in unnecessary or inappropriate pharmacy costs to date in 2025.

“Our team of clinical pharmacists reviews an employer group’s pharmacy claims for opportunities to improve patient care and/or reduce pharmacy spending,” says Mona Chitre, PharmD, chief pharmacy officer and president of pharmacy solutions at Univera Healthcare. "This includes savings opportunities with approved generics or biosimilars, finding unnecessary or inappropriate medications, incorrect dosing, and safety concerns.”

The health plan cites several examples of both member care improvements and savings for its groups:

• A member had been prescribed two different medications that, when used at the same time, had no added benefit, according to American Diabetes Association guidelines. Additionally, since 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 therapy.
• When a member was prescribed an incorrect dosage of an anti-depressant, their physician was notified of the dosing issue and a lower-cost generic alternative was suggested. The member is now takes the more safe and correct dosage, saving $3,500 annually.
• Last year using Pharmacy Concierge, a consortium of upstate New York school districts reduced pharmacy spending by more than $1 million. This program delivered similar results for this client the previous year, resulting in significant cumulative savings.
• Univera’s pharmacy team’s outreach to mental health prescribers resulted in $3.8 million in savings. The team targeted treatments that can create an unnecessary cost-burden for members, recommending transition to more affordable alternatives that work just as well.
• Through simplification, recommending streamlined medication regimens that enhance adherence and affordability, our work with ophthalmologists delivered over $760,000 in savings for our clients.
• In 2024, a member undergoing treatment for lymphoma was prescribed a brand-name medication to treat their condition. In partnership with the patient’s oncologist, Univera’s Pharmacy Concierge team transitioned the member to the generic version, saving $68,000.

The member’s provider, in consultation with their patient, makes all medication decisions, Chitre says. To learn more about Pharmacy Concierge, visit univeraforbusiness.com.