Flexing for Every Market Condition, Even a Pandemic

Woman wearing orange sweater and black backpack with shopping cart looking at empty store shelves

From mid-March to mid-April, we noticed a 414% spike in Member Portal searches for hydroxychloroquine, the anti-malarial drug that some hailed as a “game-changer” for COVID-19.

Despite a lack of clinical evidence that the drug was ever an effective treatment for COVID-19, weeks of public promotion produced shortages at pharmacies around the country.

Patients with rheumatoid arthritis, lupus and other conditions for which the drug is effective had to scramble to fill their prescriptions. We knew it was a matter of time before members might be affected.

Our first case is strong evidence of the efficacy of our solution and team:

Overcoming the Price of Panic

A 30-year old member with rheumatoid arthritis had been filling generic hydroxychloroquine for more than a year, paying around $70 per fill. When she went to refill in early April, her pharmacy said they and every other area pharmacy were out of the generic.

Her only option: Plaquenil®, the brand-name product, at $448 out of pocket.

Our system generated a Savings Alert and a Savings Notification was on the way. Here’s what followed:

  • The member logged in, saw the Alert for the same generic hydroxychloroquine she’d been taking, and clicked the “Contact My Prescriber” button.
  • Even though she was told it wasn’t available in the area, our Pharmacy Support team was able to locate generic supplies at a different pharmacy and transfer the prescription.
  • Our pharmacy technician on the case worked with the member’s prescriber to secure a full month’s supply, overriding the new rule that limits fills to 14-day supplies due to the surge in demand.

Like so many patients out there—before, during and after a pandemic—this member thought she had no good options: either pay a crippling price or suffer the health consequences. Instead, we helped her navigate the system to save money and prevent an interruption in therapy.

Whether it’s a panic-induced shortage, a “normal” price hike or any factor in an individual member’s equation, our technology responds to them all. So do our people.