Finding a Solution to Lower Prescription Drug Costs

The Rural Arizona Group Health Trust (RAGHT) wanted to gain better control of its escalating drug trend with its large, traditional pharmacy benefit manager (PBM). Having only worked with traditional PBMs in the past, RAGHT was interested in exploring how a transparent, pass-through PBM model could help lower its pharmacy benefit costs.

Under its previous PBM, RAGHT experienced an 8.6% increase in prescription costs in the plan year prior to joining Navitus. With their drug trend expected to rise as its membership continued to increase, RAGHT knew it needed to revisit PBM options to ensure it was getting the most competitive pricing and a benefit structure that met its needs.

That’s when RAGHT decided to partner with Navitus. Specifically, RAGHT was interested in reevaluating its pharmacy benefit design, including coverage of over-the-counter (OTC) drugs, implementation and clinical intervention management.

Collaboration on a Formulary Management Approach

RAGHT’s partnership with Navitus focused on addressing its unique needs and employing a dedicated strategy specific to its member population and clinical issues. The team moved forward with implementing a highly managed lowest-net-cost formulary, in combination with targeted, plan-specific prior authorization and step therapy criteria. In addition, the plan provided OTC coverage for specific classes, including proton-pump inhibitors (PPIs) and non-sedating antihistamines.

Using a vastly collaborative approach that engaged all necessary stakeholders ensured a seamless transition. The team addressed all implementation aspects and conducted an in-depth analysis of plan-specific needs.

Experiencing Lower Drug Trend

By applying the recommended improvements to its pharmacy benefit plan, RAGHT realized a 14% decrease in drug trend in the first year, despite a 4.87% increase in its membership. Formulary compliance remained very strong with no change in copay structure needed. Together, these changes resulted in extraordinary cost savings, while ensuring members continued to receive the highest quality of care.

Getting Started

Want to make a greater impact toward lowering your pharmacy benefits? Contact us at [email protected] to find out how you can take back control and start saving on your pharmacy benefits today.

“The decision to award the RAGHT contract to Navitus Health Solutions has
proven to be a financially advantageous one.”
– Consultant, Erin P. Collins & Associates