Find Wasted Spending (And Do Something About It)

How do you find actionable insights in your benefits data? This customer wanted to find ways to curb their prescription spending. They knew data could help them identify opportunities for savings, but they didn’t know where to start. In this case study, we’ll look at how this customer saved on their prescription spend using the Artemis Platform.

Learn how Artemis Health helped one client find and manage wasted pharmacy spending.

The challenge.

How do you go from thousands of pharmacy claims to actionable solutions? This is where Artemis comes in. Our proprietary data models and easy-to-use analytics tool helped this customer take action on an expensive prescription that’s available over the counter—fish oil supplements.

The solution.

The Artemis Platform makes it easy to find and track wasteful spending. In just a few clicks, we mined Rx data and found claims for members taking prescription fish oil. An individual claim can cost as much as $170, while a 90-day supply of equivalent OTC fish oil retails for about $7.

Tip: When choosing a PBM, look for one that will work with you closely on formulary management. This is not always an easy task, but it’s crucial to realizing savings in your Rx spend.

01   Artemis identified inefficient Rx spending. We utilized proprietary data models to find and analyze key prescription claims that can be considered wasteful spending.

02   Artemis calculated the cost. In this case, we found 23 members taking prescription fish oil. We broke down the spending by payer and found that the member is covering 12% of the total cost, while the employer is paying 88%.

03   Artemis recommended formulary management techniques. While adding a higher copay can help in some cases, Artemis Chief Clinical Officer Rance Hutchings recommended working with the Pharmacy Benefit Manager (PBM) to require prior authorization.

The results.

“Prescription fish oils are often used more often than necessary. They are only approved by the FDA to treat a specific type of lipid disorder involving triglyceride levels above 500mg/dL. In addition, prescription fish oils are 30-50 times more costly than similar doses found over the counter.” —Rance Hutchings, Pharm.D.,Chief Clinical Officer at ArtemisHealth

This analysis uncovered a clear opportunity for savings. The employer can work with their PBM to require prior authorization on prescription fish oil that would only be approved if:

A.  The patient has a triglyceride level above 500.

B.  And the patient has a clinical reason for not first trying over-the-counter fish oil.

The client’s potential savings adds up to over $11,000 per year.