Find Rx Benefits Savings Without Sacrificing Member Care

Many employers and advisors are concerned with the rising costs of prescription benefits. In this case study, we’ll highlight:

  • How one employer found a unique strategy for Rx savings
  • The data analytics tools needed to measure prescription waste
  • A means of containing prescription costs without sacrificing employee care
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Prescription spending is one of the top concerns facing benefits professionals. How do you control skyrocketing costs without negatively impacting your members? With data, that’s how.

Prescription benefits costs are rising by double digits each year, and this spending affects both self-insured employers and employees. One Artemis Health client wanted to address inefficient Rx spending without cutting benefits or passing costs to their members. Here’s how they did it.

Fortamet is a commonly prescribed namebrand drug for Type II diabetes. It’s an extended-release tablet that contains an oral antihyperglycemic drug, and it’s very effective for managing this condition.
Person holding glass of water and pill.

The analysis.

Artemis’ proprietary data models capture hidden insights in benefits data. With the help of clinical experts and skilled analysts, we identify quick wins for our clients. In this case, we used our “Inefficient Rx” app to find out if a generic drug substitution would help curb costs.

Screenshot from the Artemis platform Inefficient Rx app showing Employer Rx overspending of $111,911 and Sum Member Rx Overspending of $310

The de-identified data we used in this analysis showed a few key findings:

01   The employer is overspending on Fortamet by over $100,000 during the analysis period (1 year).
02   Members are also overspending, and they would stand to benefit from formulary management strategies.
Tip: Working with Pharmacy Benefit Managers (PBMs) can be tough, and they’re not necessarily incentivized to make changes. Formulary management is a must for today’s benefit managers, and PBMs are beginning to adapt to this new paradigm.

In addition, this analysis identified top providers prescribing Fortamet, the ratio of employees to spouses and dependents taking this drug, and other useful demographic information.

With help from our clinical staff, this client identified a drug substitution that’s the exact same molecular composition as Fortamet: metformin.

Here’s what we found.

Cost per Claim: Fortamet ($1,556) vs Metformin ($0.10)

Taking Action.

By substituting generic metformin for name-brand Fortamet on their formulary, this client saved over $1500 on every prescription filled. All without disrupting the care offered to their members

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.