QUALYiQ Program Delivers Significant Savings for Both Members and Health Plans

Holistic Cast Management and Financial Support

In response to these challenges, our QUALYiQ^TM program took action. Our team conducted a thorough review of the member’s case to ensure that Strensiq was clinically appropriate for their treatment. Once clinical approval was confirmed, the team focused on addressing the financial aspect of the member’s care.

The Navitus team assisted the member with enrollment in manufacturer copay assistance and grant programs to significantly reduce their out-of-pocket costs for the expensive medication.

A Strensiq dose optimization strategy was also implemented, adjusting the member’s treatment plan to ensure the necessary therapeutic outcome while lowering overall medication costs. By optimizing the dosage, we were able to further reduce the financial impact on both the member and the health plan.

Compassionate Care and Coordination

A member of one of our key accounts, a legal services organization, was responsible for caregiving and medication management for her husband with cancer. As part of his treatment plan, he was prescribed Revlimid, a specialty drug.

Supporting Patients with Specialty Drug Access

Revlimid is a limited distribution drug with specific dispensing requirements. The couple initially unsuccessfully attempted to fill the prescription at a local retail pharmacy. They faced repeated issues and frustration with the process. The situation became so challenging that the patient considered discontinuing his medication.

In response to their struggles, Navitus took immediate action. Our team worked closely with the couple to provide support. Their client services coordinator emphasized with their situation, and worked tirelessly to find different solutions to resolve the situation. Alongside our clinical team, she consulted with the couple to explore alternative retail pharmacists that could fill the prescription more easily.

To address these issues, the organization’s advisor evaluated multiple progressive pharmacy benefit manager (PBM) offerings. After careful analysis, they selected us as the ideal partner to optimize their pharmacy benefit plan. We provided a tailored approach that focused on enhancing transparency, improving rebates, and implementing effective clinical management strategies.

Partnering with Navitus led to impressive outcomes, including an overall year-over-year reduction in pharmacy plan spend. Notable improvements included a 54% increase in drug rebates, a strong copay assistance program providing $1.4 million in savings to plan members, and a 51% prior authorization approval rate.

After making the switch to Navitus, the client experienced a 47% reduction in net plan cost PMPM ($67.10 PMPM down to $39.50 PMPM) and a 32% reduction in total plan cost PMPM ($76.45 PMPM down to $52.32 PMPM).

The results were clear: Navitus brought much-needed transparency to the pharmacy benefit program, creating significant savings for both the plan and members.