More for less.

A behavioral health program dramatically reduces drug costs despite increasing utilization.

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Challenge

Reduce rising drug costs

A state behavioral health program needed to reduce rising drugs costs despite experiencing a consistent increase in utilization. The organization operates on a tight budget and receives funding to assist with paying for uninsured patients. PharmAvail won a competitive bid to implement 22,000 members in three weeks.

Solution

PharmAvail discovered that five drugs accounted for 56% of their drug spend.

Armed with this knowledge, we recommended:

• Using Patient Assistance Programs (PAP) for eligible brand drugs

• Implementing a tiered formulary

• Employing utilization management changes and prior authorization programs

Results

Between 2017 and 2019, the state behavioral health program experienced:

30% increase in utilizers and 30% increase in prescriptions filled

30% reduction in PMPM

62% reduction in drug spend on brand (PAP drugs)