AllianceRx Walgreens Pharmacy regularly performs clinical audits on its specialty claims. In 2021, the company realized $6.2 million in annualized savings through its dose optimization program, leading to an average savings of $6,173 per optimized dispense.
Specialty drugs now account for 50% or greater of the total prescription spend. In some cases, employer clients are seeing specialty costs account for 60% or even greater of their total drug spend, the company said.
“As more specialty medications come to market and are prescribed, innovative strategies like our clinical audit programs will be needed to help mitigate the increasing costs,” said William Trombatt, manager of clinical programs at AllianceRx Walgreens Pharmacy.
Dose optimization is a clinical audit program designed to directly decrease medication costs. This strategy takes major steps toward protecting a payer’s bottom line by minimizing the number of units (oral, injectable or infused) dispensed for a prescription while providing the same appropriate dose to the patient.
For example, some pharmaceutical manufacturers may charge similar prices for 5 mg and 10 mg capsules. If a physician writes a prescription for two 5 mg capsules each day, this prescription can be more efficiently and economically dispensed with one 10 mg capsule, the company said.
In 2021, the clinical audit team at AllianceRx Walgreens Pharmacy identified and reviewed approximately 300 individual patient cases. “After review, 37% of the cases were determined to be a non-opportunity — mainly due to negative financial impact to the patient, medication discontinuation or dose change. Thirty percent of the cases were successfully intervened upon resulting in an annualized savings of over $6.2 million. In 33% of the cases, the prescriber failed to respond to or declined our request,” Trombatt said.
“With this program, we are striving to help patients reduce the number of tablets or capsules they must take and decrease overall prescription costs,”he said. “This program minimizes the number of units dispensed for a prescription while providing the appropriate dose to the patient.”
Trombatt also noted that these cost savings demonstrate AllianceRx Walgreens Pharmacy’s overall commitment to reducing healthcare spending in general. “Medication costs, especially specialty medication costs, continue to grow each year,” he said. “Specialty pharmacies are in a unique position — we are the last line of defense in managing specialty spend. When it comes to the overall savings, we are able to provide in order to lower overall healthcare costs, any impact we can make to potentially lessen that spend is helpful.”