Hospital Saves Over $575K from Expert Clinical Guidance

The Challenge

A hospital system with 14,700 members and an annual pharmacy spend of $11.2M was faced with an escalating drug spend. As a hospital, their pharmacy benefit is complex, and they were dealing with the same competing priorities as many hospitals. The client needed a strategic pharmacy partner who had the hospital-specific expertise to help them offer a strong benefits package to keep their employees happy while still reducing pharmacy costs.

         Annual Pharmacy Spend

The Solution

RxBenefits provided a holistic, hospital-aligned pharmacy benefit management approach that reduced waste, optimized therapy, and insulated trend. After conducting a Comprehensive Pharmacy Analysis of the client’s previous arrangement to pinpoint the major trend drivers impacting costs, RxBenefits’ team of in-house experts were able to suggest hospital-optimized strategies:

  • Formulary optimization with low clinical value drug exclusions – removes non-essential, high-cost drugs with low clinical value from the formulary to prevent unnecessary drug spend
  • Foundational utilization management review – an independent, comprehensive review process lays the groundwork for appropriate medication use and oversight
  • High-dollar claim review – umbrella protection against spending on unnecessary high-cost medications
  • Manufacturer assistance program for specialty medications – maximizes available manufacturer-based assistance funds and protects copay accumulators while offsetting costs for certain specialty medications

The Results

Through RxBenefits’ in-depth clinical oversight, the hospital system was able to achieve significant savings and reduce its risk of exposure to unnecessary high-cost medications while still providing an excellent benefit for employees. Working with RxBenefits, the client decreased their plan cost by over $575K for clinical programs alone. Focusing on the plan’s data enabled RxBenefits to spot the trends and patterns impacting the plan’s escalating prescription drug spend and ensure that the plan utilized only the most clinically appropriate and cost-effective medications.


savings from excluding Low Clinical Value medications


in savings from non-specialty High Dollar Claim Review


in specialty savings from Manufacturer Assistance Programs

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