Workers Compensation Group – Total Savings Delivered: $43,620 Per Year
Challenge
- Member was initiated on duplicate HIV treatment by provider and pharmacy was filling both prescriptions simultaneously
- PBIRx® Clinical Consultant identified concurrent duplicate therapy claims during review of a clinical report
- Besides increased financial burden on pharmacy spend, PBIRx® Clinical Consultant was also concerned about potential clinical adverse risk perspective for this member
Solution
- PBIRx® engaged with the client and the PBM on this issue, and PBM was instructed to block claims for both the medications at Point-Of-Sale (POS) until patient’s clinical regimen could be verified with the patient’s provider
- Based on rapid clinical intervention and provider engagement, member’s therapy was adjusted to one drug regimen which eliminated duplicate therapy and more importantly, reduced risk of adverse clinical outcome for the member
- Long-term block was placed on the second drug therapy to avoid duplicate drug fills in future
- PBIRx’s swift action post issue identification and collaborative engagement efforts in cross-functional manner ensured optimal clinical outcome for the member while reducing financial burden on client’s pharmacy spend
Result
Total Savings Delivered Per Year
$43,620
