An Excellus BlueCross BlueShield program is focusing on medication safety while saving millions of dollars in prescription drug costs. The program, Pharmacy Concierge, is available to most midsize and large employers through the health plan.
“Improving care is the primary goal of Pharmacy Concierge,” says Mona Chitre, PharmD, chief pharmacy officer and president of pharmacy solutions at Excellus BCBS. “Slowing the growth in drug spending without compromising care is an added benefit.”
With Pharmacy Concierge, a team of clinical pharmacists from Excellus BCBS reviews an employer group’s pharmacy claims for opportunities to improve patient care and/or reduce pharmacy spending. This includes finding unnecessary or inappropriate medications, incorrect dosing, safety concerns, and savings opportunities with approved generics or biosimilars. Generics and biosimilars are as safe and effective as their brand name counterparts but can cost less.
“Pharmacy Concierge has saved our organization thousands of dollars in prescription management,” says Dan Ross, vice president of corporate compliance and risk management at Heritage Christian Services in Rochester, New York. “It is a great asset with minimal risk.” In 2022, Heritage Christian Services saved just under $100,000 in pharmacy costs. They are on track for even greater savings in 2023.
Last year, the Pharmacy Concierge team eliminated $11 million in unnecessary or inappropriate pharmacy spending. Nearly 900 employers participated, and more than 7.4 million claims were reviewed for potential clinical safety and/or savings opportunities.
Here are some examples:
- Pharmacy Concierge identified a member who had been prescribed two different medications to treat their diabetes. When used at the same time, the medications have no added benefit according to American Diabetes Association guidelines. In addition, one of the medications is associated with potential safety concerns. Outreach was made to the prescribing physician, who worked with the member to adjust the prescription therapy.
- The program identified a member prescribed the incorrect dosage of an anti-depressant. The physician was notified of the dosing issue. A lower cost generic alternative was also suggested. The member is now taking the correct and safer dosage, with an annual out-of-pocket savings of $3,500.
- A consortium of upstate New York school districts reduced pharmacy spending by more than $1 million after participating in the program.
Chitre says all medication decisions are made by the member’s provider in consultation with their patient.
“Our employees at Heritage Christian Services get a knowledgeable resource that can answer their questions, and our organization sees significant savings with reduced pharmacy costs,” says Ross. “It’s truly a win-win!”
In the first six months of 2023, the clinical pharmacists have identified $10.8 million in unnecessary or inappropriate pharmacy costs.
Learn more about our Pharmacy Concierge Program.
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