No, we are not a pharmacy benefit manager, nor do we replace yours. We are an additional pharmacy service that layers over and works in conjunction with your existing program to help navigate and optimize your prescription benefit. We are PBM-agnostic and work with many of the largest PBMs.
No, we are also health plan-agnostic and work within your existing plan design. In fact, many of our customers are health plans.
We find additional savings beyond your plan and formulary design by comparing member claims data against available savings opportunities that come from various therapeutic equivalents, dosage optimizations, brand-to-generic and generic-to-generic substitutions, alternate fulfillment channels and other recommendations curated by our in-house pharmacists. Unlike most pharmacy plan designs, our solution is dynamic and continually updated with the newest pricing information, so savings opportunities can be realized immediately rather than the next plan year.
No, we give members the ability to search for any medication to find the best prices and any lower-cost but therapeutically equivalent options available. However, what separates our solution from other tools is the ability to proactively notify members via email and text message about savings opportunities they already have.
Rx Savings Solutions was founded by a pharmacist and is staffed with in-house, licensed pharmacists who provide ongoing oversight. Our “suggestions engine” is maintained and constantly curated by this pharmacy team. We use the Gold Standard clinical database, which is updated daily and includes all pertinent U.S.-approved drug product data and images with professional monographs and corresponding patient education. All recommendations are based on the same peer-reviewed, evidence-based compendia that hospitals, health plans, Medicare, Medicaid, and PBM’s use to establish coverage criteria and evaluate approved/non-approved uses.
The beauty of our offering is that it has proven to work for groups of all sizes, regardless of industry, PBM, or whether the client works with a consultant. We currently serve groups as small as 5,000 members and as large as 700,000, with demonstrated success in a variety of industries, including health plans, government, healthcare, financial services, retail, manufacturing and communications. We work with a growing number of consultants and welcome their involvement in the discussions around our solution.
Email is currently the primary medium for member communications and outreach. This includes initial member engagement (registration) campaigns as well as routine follow-up emails alerting members to savings opportunities. Critical to our proactive approach is the ability to contact members, upon their approval, via text messaging. We offer turnkey as well as custom-designed and client-approved marketing plans, depending to what degree the client prefers to control the message.
Valid email addresses are necessary for members to take full advantage of the Member Portal and the array of services available. However, to encourage member engagement and registration, we often utilize printed promotional and informational materials, reminders and direct mail to communicate with populations for whom email use is neither common nor practical during the business day. Members may also call our Member Services team for assistance with registering, savings opportunities, prescriber and pharmacy interactions, and any questions they may have.
The majority of recommendations consist of therapeutic equivalent alternatives and dosage optimization for chronic medications, as well as simple price shopping. Rx Savings Solutions utilizes a patented algorithm that exhausts all clinical and fulfillment alternatives in search of a savings. About 75% of savings are the result of a clinical suggestion and 25% of savings come from fulfillment changes.
By definition, specialty medications typically don’t have as many therapeutic alternatives available as traditional products do. However, we advise and educate members on specialty medications to maximize whatever generics or biosimilar options are available, and to utilize available manufacturer coupons and rebated products that are commonly available in the specialty class. In cases where a mature or saturated therapeutic class exists, members are steered to the lowest-cost medications with the same indications.
The biggest difference is purpose and function. MTM programs exist to optimize therapeutic outcomes by actively managing drug therapy and by identifying, preventing and resolving medication-related problems. We exist to provide personalized and proactive pharmacy guidance within the existing benefit, with the goal of saving the member money. Essentially, the respective goals are clinical vs. financial optimization.