No TPA is more vigilant in helping you contain your drug costs.
Prescription drugs are a huge line-item cost for company health plans. In fact, they can make up 20% (or more) of a company’s health care costs. The expertise, review protocol and supplier relationships necessary to manage this cost of care are built into our system.
Our staff Doctor of Pharmacology leads one of the most knowledgeable review teams in the healthcare industry. The team reviews all high-cost prescriptions. If they identify a compliance issue, they alert both the member and the plan administrator. And when they identify possible over-billing or potential lower-cost alternatives, they reach out directly to providers to address the issue and discuss options.
Our Pharmacologist works with each company to develop the right balance of cost and coverage) like the range of covered drugs offered by the plan) for its needs. Our focus on creating the smartest formulary means providing the treatment patients need at the greatest discount possible.
To ensure the lowest costs for our clients, Leading Edge works with all major Pharmacy Benefits Managers (PBMs).
Pharmacy fee structures are another area where we help clients build in savings to their plans. Leading Edge works closely with each company to select the most optimal fee structure (capitated rates, transactional, rebate shares). Don’t worry, we can explain all of this simply and clearly.
Here’s how we saved a company $6,600 and saved an employee from jeopardy.
The employee, suffering from Rheumatoid Arthritis, had failed on two major drugs. The Rheumatologist recommended a new treatment in which the starter kit alone was $6,913.40.
A major concern was that the patient only had a $7,500/year family drug benefit. Our team discussed with the Rheumatologist the possibility of using a therapy that had not yet been tried for the patient—one that was a great deal less expensive. The doctor agreed to it as a good ‘next step’ option. The treatment was indeed successful. Not only was the savings to the plan $6,600, but the patient was able to maintain a healthy drug benefit balance in his account.