Success Stories
NAVITUS | 2024 Drug Trend Report
Delivering double-digit savings in year one
Our client, a nationwide employer, partnered with us in 2024. Through the application of our pass-through, lowest-net-cost formulary management model, we achieved a cost reduction of 17.1% in the first year.
This client also implemented our personalized member transition (PMT) program to proactively help members transition to their new pharmacy benefits. Thanks to the high-touch support from our skilled clinicians, members rated their experience as overwhelmingly positive with a 98% customer satisfaction score.
Delivering savings for the long term
Our client, a regional building materials supplier, partnered with us in 2020. We were able to not only save them millions in the first year alone, but also keep them at a negative trend over the following years. Much of this was accomplished by the implementation of: our lowest-net-cost formulary, our pass-through model which eliminated spread pricing and rebate chasing, the Lumicera cost-plus specialty pharmacy and a preferred pharmacy network.
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Helping human beings
Amanda is Lumicera’s Manager of Experiential Learning and Chair of their accredited Oncology Center of Excellence. Since 2023, she has been a specialty pharmacist at Lumicera.
She loves working with her patients and team. For the last two years, she has also been a caregiver for a cancer patient…her son.
Images are not of the person depicted in this story and are for dramatization purposes only.
During the summer of 2023, Amanda took her 10-year-old son to his pediatrician to help break a fever caused by a virus. In every sense, it was a routine visit. Since she was already there, she decided to take advantage of the appointment and asked the doctor if he could take a look at a small lump that had appeared on her son’s leg a few days earlier. The pediatrician ordered an X-ray on the lump right away.
His diagnosis was two words that forever changed Amanda’s family:
“It’s cancer.”
“How can you ever describe that feeling of hearing those words,” Amanda said, holding back tears. “This isn’t something you think about for a child — especially your own child.”
She went on to say it was even more difficult because she had just finished the oncology rotation in her pharmacy residency program and understood the implications.
The next 12 months were some of the most difficult Amanda has ever had to face.
As her son was going through treatments, Amanda was also finishing up her pharmacy residency program. In fact, after being in the hospital for several days during a treatment for her son, Amanda had to fly out to present her research on targeted therapies for breast cancer at a conference. It was during this very busy, emotional time that Amanda realized she was in a position to help advocate for patients who were going through what her son was experiencing.
“He didn’t ask for this.”
Amanda admits one of the hardest parts was switching between being her son’s clinician and being his mom. When the team of doctors would come in to evaluate and provide insights into her son’s progress, she was in full clinical mode, listening and providing feedback to the doctors as well. As soon as the doctors left, she went right back to being mom. She was exhausted, but knew how important it was to be able to be present as both.
There were so many times Amanda struggled. One day her son asked her, “Why did this happen to me?” She was devastated. As his parent, she wanted to have the answers, but she too had been saying to herself, “He didn’t ask for this.”
Amanda looks back on moments like that now and makes sure she shares these insights with patients and their caregivers, because she knows how important it is that people understand they’re not alone. There are others who are going through what they’re going through, and they’re struggling, too. “We cried so hard that day [my son asked the question],” she said. “I just knew I needed to be there for others.”
She makes sure to share the bright spots, too.
The specialty pharmacy team at Lumicera helped coordinate the benefits and did all the investigative work for her son’s medications. Getting approval and access to life-saving cancer medications can be a long, drawn-out situation. However, Lumicera’s streamlined process made it easy for both Amanda and her son’s doctor. Even the doctor remarked about the speed in which the specialty pharmacy turned around the prescription.
Another wonderful experience occurred when Amanda’s family was connected with an organization called Special Spaces, a local, non-profit that creates dream bedrooms for children with cancer. Their goal is to provide a safe space where the child can sleep, play and just be a kid.
Special Spaces interviewed Amanda’s son to understand what he liked, then sent the family to a hotel for the night so they could work on his bedroom. When the family arrived back at their home, they were greeted by the team that redecorated his room holding signs and cheering for them. It was a wonderful moment they will never forget, especially the huge smile on her son’s face when he saw his new room.
One year later, her son is cancer-free and thriving. “To look at him, you’d never know what he went through during that year,” she said. “What we all went through.”
After Amanda graduated and became a specialty pharmacist, she took on an additional role at Lumicera as the Chair of the Lumicera Oncology Center of Excellence. She knew that, in this role, she could be a voice for cancer patients, help with copays and insurance, and provide more than just the medications.
NAVITUS | 2024 Drug Trend Report
NAVITUS | 2024 Drug
Trend Report
Download the
Drug Trend Report
Executive Summary
Download the
Full Drug Trend
Report
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Methodology
The Navitus drug trend is calculated by comparing the net total cost PMPM for 2024 to that for 2023. Net cost PMPM represents full-year (Q1-Q4) data for total member copays and plan paid amounts, minus manufacturer rebates and fees. This value is divided by the total number of members and by 12 months of the year.
Net total cost PMPM trend consists of two components — utilization and cost — and includes both specialty and non-specialty drugs. Utilization trend measures the change in total days of therapy. Cost trend measures the change in net total drug cost per day of therapy. This analysis included data for more than 600 clients, representing 3.4M members within Navitus’ commercial book of business, including employer plan sponsors and health plans. To be included, these organizations must have been clients of Navitus in both 2023 and 2024. Exclusions from this analysis include products administered at physicians’ offices, clinics and hospitals, products subsidized by the federal government (i.e. COVID-19 vaccines/treatments), products excluded by benefit design (weight loss, infertility) and any additional savings from copay assistance programs.