Results Driven Pharmacy Claims Management

Current Trend in Pharmacy

1 - 2% of pharmacy claim volume accounts for 45 - 50% of pharmacy plan cost. This statistic is predicted to get worse. Employer sponsored health plans drastically need an innovative Pharmacy Benefit Manager to manage pharmacy claims, instead of simply processing them.

True out of Pocket Reporting

In 2017, MedalistRx began a new process of managing brand medications, we titled this program True out of Pocket Reporting. It was crucial that this program lowered both client and member prescription costs. The implementation process was seamless with minimal to no member disruption. Members utilizing brand medications were guided to manufacturer support programs which greatly reduced or completely eliminated their out of pocket cost. This process worked hand in hand with MedalistRx proactive Every Claim, Every Day approach to pharmacy claims management.

After a successful implementation process, our claims team began tracking the true member contribution after manufacturer resources were utilized. The chart below details the programs savings for 2017, 2018, 2019, & 2020.

High Level Savings

MedalistRx saved clients $7.4 million in pharmacy plan cost and member copays through a proactive approach to utilizing available manufacturer resources. The True out of Pocket Reporting program resulted in a 36% reduction in client plan cost for brand medications. Members in our program paid a minimal 4% of their brand copay resulting in a 96% drop in member out of pocket expense for their medications.

Looking Ahead

MedalistRx will continue to manage high cost brand and specialty claims by utilizing a proactive model that maximizes available manufacturer resources. True out of Pocket Reporting for deductible and maximum out of pocket tracking allows a brand medications resources to be utilized on multiple refills. This proven program will continue to save our clients millions in plan cost, while protecting our membership with a minimal or $0 copay. MedalistRx True out of Pocket Reporting program saves our clients on the greatest current and future employer benefit concern: high cost brand medications.

NICK RISTAU

Senior Account Manager, MDRX