Intermediary Insurance Services, Inc. (iiSi) Endorses RxResults
We have seen a spike in the cost of specialty drugs, which represent 1% of the all prescription drugs dispensed, however they account for 35%+ of all drug costs. It is anticipated that specialty drug costs will reach 50% of all drug expenditures. In an effort to stem the high cost of specialty drug use, iiSi has endorsed a pre-certification program provided by RxResults.
RxResults is an evidence-based pharmacy risk management company that provides an independent pre-authorization service for specialty drug dispensing. RxResults finds that through their pre-certification process that 68% of the prescriptions are approved, 12% are withdrawn and 20% are denied. This process eliminates 30%+ of the specialty drug prescriptions. One of their notable observations is only 36% of the hep C prescriptions are approved being many are denied as not meeting the drug’s clinical criteria. RxResults is seeing savings anywhere from 12% to 45% with their Specialty Drug Management program.
The benefits of this program are:
- Controls the utilization of specialty drugs
- Eliminates the conflict of interest with PBMs providing their own prior-authorization, which is advantageous to the PBM’s bottom-line along with the distributor receiving incentives and rebates
- Reduces Plan costs by recommending lower cost alternatives
- Detailed drug analytics leading to evidenced-base determination of prescribed specialty drugs
- Reduces the frequency of lasers and increases in aggregate attachment point factors
This is a first step in helping to address rising specialty drug expenses. For more information contact L.G. Hanzel, Principal & VP of RxResults at (817) 296-8147 or visit the RxResults’ website at www.rxresults.com.