- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
Helping Mitigate the Impact of Price Outliers.
As part of our continued commitment to help prevent waste and unnecessary spending, and to ensure appropriate utilization of medication we target and remove drugs with artificially inflated price tags also known as "hyperinflated" from our formularies that have readily available, clinically appropriate and more cost-effective alternatives.
A flexible approach and quarterly removals — rather than annual reviews — help ensure that clients can stay ahead of rapidly changing market trends.
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To further complement these strategies, we have weekly new-to-market (NTM) reviews assessing new drugs that are priced significantly higher than other clinically equivalent alternatives. When evaluating NTM products for inclusion on our formulary, we do not add drugs that have far higher prices than clinically appropriate alternatives in their therapeutic class.
Through July 2022, a total of 67 drugs were blocked initially at launch through the NTM process.
Our flexible management approach allows us to focus both on the drugs and dispensing pharmacies.
Hyperinflation strategy lowers costs for clients and members
Launched in 2017 to target drugs seeing very high inflation from one year to the next, we expanded our hyperinflation strategy in 2019 to target price outliers within a therapeutic category for even better cost control.
Through July 2022, we helped save clients $563M through our hyperinflation management strategies.
We continually review and identify drugs that are seeing high price increases and those that are outliers based on price, including new market entrants, and remove such therapies from our managed formularies. During this same period, we identified and removed 16 hyperinflated drugs from our template formularies. Utilization of drugs that were price outliers in their therapeutic class dropped by 92.4 percent, saving clients an average of $2.32 per member per month.