RxBenefits’ Vice President of Clinical Services, Mark Campbell, PharmD, sat down with Health Professional Radio to discuss RxBenefits’ pharmacy benefits optimizer model. He shared how clinical management within prescription drug programs maximizes both the clinical and economic value of pharmacy benefits for employers and their members. The following is a brief excerpt; you can listen to the full interview here.
Talk a little about the clinical management programs that you provide to your employers and their members – and how to support patient safety and health outcomes overall.
“From a clinical standpoint, the world has changed a lot in the last 20 years. Twenty years ago, we didn’t really have specialty medication. Our focus was on making sure we were improving generic utilization and ensuring the higher cost brand medications were used appropriately. Today it’s very different.
A brand back then might have cost $70, where a brand today is over $400, and a specialty medication is over $5,000. As we look at helping plans manage this, we can take a variation of what used to be the 80/20 rule, which is now a 98/2 rule. Roughly 2% of members account for about 60% of the costs in most plans, so focusing on seeing what we can do to help those members maximize both the clinical value and the economic value is tremendously important. It really zeroes in on the things that are going to be most beneficial to a plan. Whereas twenty years ago, we might have ruled out a program that could have affected 20-40% of the member population, today it’s more focused – almost laser-like – to hit those areas where we think there is an opportunity to provide significant benefits.”