Managing Pharmacy Costs with Integrated Data: The Playbook for Plan Sponsors

Plan sponsors face an increasingly complex challenge: effectively managing the high costs of innovative and life-changing medications while providing appropriate treatments for their employees and members. From treatments that cure diseases to managing obesity to enhancing quality of life, we are seeing a surge of groundbreaking drugs. However, these advancements often come with a steep price tag, with some treatments costing tens of thousands or even millions of dollars.

Leveraging integrated data has become extremely valuable for plan sponsors seeking to better manage their pharmacy benefit. By combining pharmacy and medical claims data, organizations can unlock a comprehensive view of their spend, empowering them to anticipate the impact of new drugs, minimize member disruptions, and optimize budget management and affordability.

The Playbook: Tackling Key Pharmacy Challenges with Integrated Data

To demonstrate the important role of integrated data, let’s explore some of the challenges that plan sponsors face and how using pharmacy and medical claims data can provide invaluable solutions.

Download the playbook for a more detailed example of each clinical topic.

GLP-1s: Mitigating Costs and Ensuring Appropriate Use

GLP-1s, a class of medications used to manage Type 2 diabetes, obesity, and cardiovascular disease, have witnessed a growth in popularity due to their effectiveness for weight loss. However, with annual costs reaching $12,000 per member before rebates, managing the utilization and costs of these therapies is as important as ever. Integrated data empowers plan sponsors to identify members without a diabetes diagnosis who may be using GLP-1s off-label. This enables them to implement targeted utilization management strategies, which we suggest be coupled with a behavioral or lifestyle modification program. This will help ensure clinically appropriate use and lower costs.

Biosimilars: Optimizing Cost Savings

Biosimilars, more affordable versions of brand-name biologics, offer a promising alternative for cost savings. However, their adoption has been slower than anticipated. By combining pharmacy and medical claims data, allowing insight into diagnosis for use, plan sponsors can pinpoint areas where biosimilars can be leveraged in place of costlier brand-name drugs, maximizing cost savings. To further enhance member experience, we suggest plan sponsors create a communication strategy for patients to ensure a seamless transition.

Cell and Gene Therapies (CGTs): Anticipating Costs and Identifying Candidates

Transformative yet expensive Cell and Gene Therapies (CGTs) hold the potential to provide long-lasting support for patients with cancers and rare genetic conditions. With costs ranging from $400,000 to $4.3 million, anticipating the financial impact of these therapies is critical. Integrated data allows plan sponsors to identify members who may be candidates for CGTs based on intricate criteria, creating a data-driven approach for proactive budgeting and risk management strategies.

Alzheimer’s: Preparing for Promising Treatments

As promising new treatments for Alzheimer’s disease, such as Leqembi and Donanemab, continue to emerge, plan sponsors must be prepared for potential member demand and associated costs. Plan sponsors can use integrated data to identify members who have early-stage Alzheimer’s or mild cognitive impairment and who may be eligible for certain therapies. This allows them to prepare for the budgetary impact of the treatment while also optimizing utilization management to ensure that the requested drug is used in a safe and appropriate manner.

Take the Next Step: Unlock the Power of Integrated Data

Plan sponsors can turn to Artemetrx to harness the power of integrated data to drive strategy backed by comprehensive analysis. Artemetrx is an integrated platform that transforms data into intelligence, driving improved drug spend and trend management across pharmacy and medical benefits. Built on 30 years of drug management expertise, the web-based platform provides users with reports, dashboards, and tools, bringing efficiency, precision, and scalability to drug management.

Integrated data has become critical to the success of a plan sponsor’s pharmacy benefit, equipping them with the tools to navigate complexity, mitigate costs, and ensure clinical appropriateness. By leveraging integrated data, organizations can comprehensively understand their costs, anticipate the impact of new therapies, and implement data-driven strategies to optimize their drug programs. To learn more about how you can use integrated data to support your own business, download our comprehensive playbook.