QALYiQ Program Delivers Significant Savings for Both Members and Health Plans

As part of their treatment plan for hypophosphatasia (HPP), a rare genetic disorder affecting bone and teeth development, one of our members required Strensiq, a medication designed to manage HPP. However, Strensiq’s annual treatment costs ranged from $1 million to $3 million, creating financial challenges for both the member and the plan, one of our key accounts with 3,000 members.

Holistic Cast Management and Financial Support

In response to these challenges, our QALYiQ^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.

Making High-Cost Treatments Accessible and Sustainable

The proactive, data-driven approach of the QALYiQ^TM program, saved the plan $190,000 annually through a combination of financial assistance programs and optimized treatment regimens. For the member, this intervention resulted in reduced out-of-pocket costs, while ensuring they continues to receive necessary treatment for their conditions. QALYiQ^TM is one of the important programs included in the Navitus Key solution.

Ready to learn more about managing costs to control trend?

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