Ever committed to helping reduce overall pharmacy spend for patients and partners, 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.1 

“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,” says William Trombatt, PharmD, CSP, 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- 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.2

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 says.

“With this program, we are striving to help patients reduce the number of tablets or capsules they must take and decrease overall prescription costs,” Trombatt says. “This program minimizes the number of units dispensed for a prescription while providing the appropriate dose to the patient.”

Trombatt says these cost savings demonstrate AllianceRx Walgreens Pharmacy’s overall commitment to reducing health care spending in general. “Medication costs, especially specialty medication costs, continue to grow each year. 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 health care costs, any impact we can make to potentially lessen that spend is helpful,” he says.

Sources

1Health Plans Brace For Specialty Drugs Eclipsing 50% Of Prescription Spending 2 Dose Optimization Interventions Yield Significant Specialty Drug Cost Savings