Health system expands in-pharmacy use

Overview

A health system sought a partner that would help them to operate their own PBM, give them direct access to an easy-to-use adjudication and benefits platform, enabling them to:

• Utilize their internal pharmacy assets (e.g., dispensing channels, 340B purchasing) to their full potential

• Work with a partner they could lean on operationally, clinically, and strategically

• Generate additional revenue streams

• 65,000 employees and dependents

The Solution

With RxIQ® Enterprise and RxSense as their partner, “Health System” launched their PBM within months. Since launch, they have been able to:

• Utilizing internal pharmacies, including specialty

• Contract Direct with third party for Rebate Management

• Utilize RxSense for pharmacy network, LDD Specialty Wrap

• Optimize script volume, savings, revenue through their dispensing channels, and 340B purchasing strategies

• Create the ability to administer a PBM program to local employers and drive additional volume into in-house pharmacies

The Results

After partnering with RxSense, "Health System" saw the following pre and post shift to in-house pharmacy utilization:

• In-house claims increased 130% (from 18% to 41%)

• Specialty medications share increased 164% (from 36% to 95%)

• R90 medications share increased 363% (from 21% to 97%

In total, the health system saw $7MM in annualized savings in year one