The Challenge
A non-profit East Coast hospital was struggling to control its exploding specialty drug spend. Under its PBM contract, the hospital was unable to drive utilization to its on-site pharmacy, and employees were not incentivized to use the hospital-owned pharmacy. Instead, scripts were being driven to PBM-owned pharmacies. This diversion was amplified by a lack of PBM support for in-house pharmacy overrides. The misaligned relationship caused the hospital to miss out on critical savings opportunities from in-house fulfillment and 340B drug pricing. The result was a conflicting, inconsistent service experience.
The Solution
As an independent Pharmacy Benefits Optimizer (PBO), RxBenefits offered the hospital a flexible, transparent pharmacy benefits solution that leveraged the
hospital’s own resources and aligned with its savings and service objectives.
- Channel-agnostic pharmacy benefits contract provided drug pricing transparency and positioned the hospital to promote utilization of its on-site pharmacy using copay incentives
- 340B contract pharmacy network was created to include specialty pharmacies, expanding the hospital’s 340B program reach and leading to additional savings
- Proactive member communication engaged employees who weren’t utilizing the on-site pharmacy or contracted pharmacy network so that the hospital could bring those prescriptions back in-house
- Coordinated clinical management led by RxBenefits’ clinical team who identified the best approach to high-dollar prescriptions and directly engaged with hospital pharmacy staff
The Results
Overall Optimization Results:
Working with RxBenefits, the hospital experienced a more transparent, collaborative relationship aligned with its goals. RxBenefits’ total solution helped the hospital rein in its high-cost prescription drug spending and provided needed support for its in-house pharmacy and 340B program successes.
