School Board Saves
$7.30 PMPM in Just 6 Months
with Rx Problem-Solving
The Dayton Board of Education, with an average of 3,438 monthly members, had an annual pharmacy plan spend of $5.8 million. Unfortunately, the board’s overall pharmacy spending trend had increased steadily from $95.84 per member per month (PMPM) in the first quarter to $164.44 PMPM in the fourth quarter – averaging $141.14 PMPM for the year. Facing these increased costs, the board needed a strategic pharmacy benefits partner who could implement targeted, clinically based pharmacy savings programs and provide ongoing guidance to help lower their annual pharmacy spend in a sustainable way.
The Dayton school board worked with RxBenefits’ expert clinical team to apply the following Protect components to address the plan’s top risk areas and decrease pharmacy benefits costs:
Low Clinical Value Formulary Exclusions – RxBenefits removed a combination medication known as Duexis® that was costing the plan $2,400 for a 30-day supply. In its place, members received over-the-counter-alternatives Advil® and Pepcid® that cost about $18 for a 30-day supply, achieving the same clinical outcome at a much lower cost.
High Dollar Claim Review – RxBenefits’ team of pharmacists reviewed the plan’s high-cost claims (those that exceed $1,000 per month) to determine their clinical necessity and identify any lower-cost alternatives. The plan’s three most expensive medications, Gattex®, Epclusa®, and Kalyeco®, accounted for a combined annual plan cost of more than $1.28M.
The school board was able to reverse the trend of increasing prescription drug costs and deliver an improved pharmacy benefit program to its members by implementing a tailored combination of RxBenefits’ Protect strategies. Over the first half of the year, the school board decreased their average plan spend significantly — the LCV program alone provided an estimated savings or cost avoidance of $29,704, while the High Dollar Claim Review program produced an additional $120,880 in estimated savings on reviewable non-specialty high dollar claims, within the first six months of the year.
Originally published on: September 16, 2020
Updated on: December 19, 2023