Manufacturing & Construction
Flume Health Concierge
ApproRx transparent PBM
Scriptsourcing specialty drug management
When a building supply company in the Southeast hired Flume Health, they were spending nearly $491,762 a year on just two drugs—Cimzia and Stelara. Their previous Aetna plan had offered no option but to pay full retail price.
The two members (one taking each drug) were both hitting their $2,000 out-of-pocket maximum on the cost of their medication alone.
Working with one of our Rx partners, we implemented a transparent pharmacy program and found a way to bring down the costs of both drugs.
The plan sponsors already knew which member was taking Cimzia. Following Flume’s advice, they reached out to him about enrolling in a Manufacturer’s Assistance Program (MAP). These programs, which are available through the drug manufacturer, provide huge discounts for people who meet certain financial criteria.
Sixty days after the plan went live, the member was accepted for the MAP, reducing the plan’s cost from $52,929 to $10,730 for a 90-day supply. The MAP also meant that the member no longer had any out-of-pocket costs associated with that drug.
The plan sponsors didn’t know which member was taking Stelara. Flume Health watched the plan’s incoming prescriptions, and when Stelara popped up, we flagged the drug for review. We worked with our Rx partner and the plan’s Pharmacy Benefits Manager to have the drug sourced internationally, without ever having to involve the member.
This reduced the cost of the drug from $22,777 to $11,594 for a 30-day supply and eliminated the member's out-of-pocket costs for that drug.
Grant Parker (Flume Health) speaks with Bryan Bickely (Scott Insurance) about the amazing results of unbundled, independent plan design
In the final installment of our recurring series on healthcare arbitrage, we round up a few other tactics which don't require as much ongoing involvement, but which can still provide important savings opportunities.