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Health benefit consultants can help their clients achieve substantial savings on prescription spending by working with BenMedica. We have a proven track record of $12 savings per member per year. Our latest enhancements for drug messaging demonstrate a projected savings of $88 per member per year across just 8 therapeutic areas.

With routine claims data analysis, we can track results, adjust as needed, and continue to lower prescription costs for your clients.  For new clients we project savings based on claims history in our analysis.

Communicating Pharmacy Benefits

The crux of our solutions is communicating actionable pharmacy benefit information to physicians during patient visits. When physicians can see medication costs in their prescribing system and coverage data along with therapeutically equivalent alternatives, they can conveniently select more affordable drugs.

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Typical Electronic Prescribing Information

A physician might decide her patient needs Livalo. The data appearing in most systems today from the typical pharmacy benefit manager (PBM) indicates only basic coverage information like formulary tier. This communicates how preferred a drug is and some drug cost indication, but not what the patient can expect to pay at the pharmacy.

Enhanced Electronic Prescribing Information

Enhanced information is available in existing physician workflows and doesn’t require visits to websites or apps. With this information, the doctor can see that a 30-day Livalo prescription costs her patient $80 and a 90-day mail order prescription costs $160.

 

The physician can also see alternatives by equivalent dosing and patient cost. In this case, a 30-day prescription for Atorvastatin will cost the patient $3; a 90-day mail order prescription costs $6. Access to this information ultimately saves the patient $77 per month at retail and helps the doctor avoid callbacks and prescription changes due to patient cost issues.

These displays can also be enhanced to include total medication cost to further inform physicians who may be at risk for drug costs.

Prescribing more affordable drugs for patients also reduces payer prescription spending. In this example, payers can save $170 per prescription (or $2,040 per year) by providing doctors with the information they need to find affordable alternatives for their patients.

We help scale these results across health plans to achieve unparalleled savings.

Price transparency is another factor in helping doctors choose the best drugs for their patients. Our tools help doctors understand estimated retail costs, supporting better drug decisions for patients who have a high-deductible plan.

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Enhancing Digital Health Technology

Our solutions integrate with existing digital health technology, allowing better information to be displayed to doctors seamlessly. BenMedica-enhanced formulary data provides doctors with the information they need to select affordable treatments for their patients.

Since all the work is done behind the scenes on data fed into electronic health record systems, there’s no new software, website visits, or mobile device usage needed and no disruption to a doctor’s current workflow to access enhanced information.

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Capturing Value for All Stakeholders

Our process provides value for all prescription cost stakeholders. Health plans and employers can save millions each year on avoidable drug costs.

Even modest physician participation can yield significant savings. For instance, a 500,000-member plan can save $19.4 million each year if doctors adopt only 40% of our more preferred recommendations.

Getting Started

We can deliver optimized formulary data in as little as eight weeks. Contact us to begin the process of analyzing claims data to estimate the savings for your clients.