RxAdvocate October, 2024 — Newsletter

October 10 RxAdvocate October, 2024 — Newsletter

Did You Know?

Specialty medications are prescription medications that require special handling, administration, or monitoring. These drugs are used to treat complex, chronic, and often costly conditions, including cancer, rheumatoid arthritis, plaque psoriasis, and Crohn’s disease. Specialty medications often must be dispensed through a mail-order specialty pharmacy, not regular retail pharmacies. Typically, greater than 50% of total plan spend can be attributed to specialty medications, while they are only used by less than 2% of members on the plan.

Examples of specialty medications you may have seen in your own prescription utilization data include Stelara, Skyrizi, and Humira, to name a few. Ways a member would know if they were taking a specialty medication include if it requires special handling, is only available through a designated specialty pharmacy, needs close monitoring by the doctor, is very expensive, and requires a prior authorization from the insurance company. If there are any doubts about whether a member is taking a specialty medication, it’s always best to consult with their doctor or pharmacist.

Recently, we have seen the addition of several biosimilars in the specialty space. For all intents and purposes, you can think of biosimilars like generics. While they’re not an exact copy of the brand name reference product, they behave the same with no meaningful clinical differences. Since the launch of the first biosimilar in 2015, biosimilars have generated nearly $24 billion in savings.

Look for our educational video on all things biosimilars to be released in November!

In October 2023, RxConnection’s Audit Team was awarded the largest audit project they have done, it included a 5-year fiscal lookback of the State of Indiana’s Employee group and Medicaid plans. After nearly a year of working on this project, Jeff Post and Ray O’Neel presented the preliminary audit report to the Attorney General in August. They presented in front of the Health Care Cost Oversight Task Force, a bipartisan committee tasked with reviewing health care costs in Indiana and making legislative recommendations to reduce costs.

If you are interested in plan design auditing, contact your Strategic Account Executive to discuss how our Audit team can assist with financial risk management.

Nontraditional Approaches to Healthcare

6.5% of children in the U.S. have asthma, with an average cost of $490 per emergency room visit. Massachusetts has a higher than average burden (9.7% of children with asthma) and decided to expand their in-home community health worker model to see if they could improve knowledge, access to healthcare, education on how to better control asthma, as well as increase the number of symptom free days.

Home visits by a community health worker for children with asthma in Massachusetts led to significant cost savings. 70% reduction of $343 patient cost savings to MassHealth, showing that nontraditional models in the U.S. can have benefits and cost savings for plans.

Breast Cancer Awareness Month

October recognizes Breast Cancer Awareness Month. Breast cancer is the most common type of non-skin cancer in women in the United States and accounts for approximately 30% of all new cancer cases among women. 1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime. Approximately 310,720 women and 2,800 men in the United States will be diagnosed with breast cancer.

Early detection and treatment methods have increased breast cancer survival rates significantly in recent years, and there are currently over 4 million breast cancer survivors in the United States. A few ways to help reduce the risk of breast cancer that are in our control include maintaining a healthy lifestyle such as diet and exercise, avoiding smoking, limiting alcohol consumption, and scheduling routine screenings with your health care provider.

Welcome, New Hires!

Please welcome Zach Jones to the RxConnection team! Zach has joined our team in Sales. He is located in Bethlehem, PA.

Zach brings over a decade of experience in the wholesale insurance markets, primarily focusing on the disruptive cost containment solutions for self-funded employers. He has spent time working with brokers, TPAs, PBMs, and reinsurance carriers on a national basis delivering insight and executing solutions that have delivered millions of dollars of savings back to employer’s health plans. We are excited to have him onboard!

Please welcome Tori Tebbe to the RxConnection team! Tori has joined our team as a Clinical Account Executive. She is located in Sylvania, Ohio.

Tori graduated from one of the top pharmacy schools in the nation, Ohio Northern University, and brings over 6 years of pharmacy experience in the community setting. Tori has experience as a pharmacy manager with efforts in managing the highest volume CVS store in Ohio, which led to being selected into the Emerging Leaders Program for district management development. We are excited to have her join the team!

RxConnection 2024 Company Outing

The RxConnection team gathered in Atlanta, Georgia to dive into the industry trends and discuss ways to continue fiercely advocating on behalf of employers and empowering leaders to take back control of their pharmacy spending.

While insightful content and key strategies were learned for continuing to do our best work and live our best lives, RxConnection also shared memorable team bonding!

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