Maximizing Savings

Ethica Drives 37% Reduction in Pharmacy Spend with Data-Driven Clinical Strategies

Client: Large Employer

Overview

During a procurement process, Ethica negotiated significant savings by examining price point concessions across multiple PBMs. However, we took a deeper approach by analyzing the client’s actual drug mix. This allowed us to identify additional savings through clinical solutions, including Prior Authorization, Step Care Edits, Quantity Limits, Copay Assistance, and Accumulator initiatives. By tailoring the clinical strategy to the client’s specific needs, we provided a more accurate and impactful savings projection.

Solution

Rather than focusing solely on price concessions, we used the client’s drug utilization data to better understand how clinical solutions could reduce overall costs. Our team identified areas where clinical management tools could reduce unnecessary spend without compromising care, such as:

• Prior Authorization: Ensuring only medically necessary drugs are prescribed.

• Step Care Edits: Guiding patients toward lower-cost therapies when appropriate.

• Quantity Limits: Controlling the metric quantities of medication.

• Copay Assistance Programs: Reducing out-of-pocket expenses for employees and the Plan.

• Accumulator Initiatives: Maximizing savings by managing drug accumulations effectively.

Results

• 37% total savings off gross pharmacy spend.

• Improved alignment between clinical management strategies and client goals.

• Significant impact from strategic management of high-cost drugs and clinical solutions.

• The employer ultimately decided to switch PBM vendors, as the value of clinical management solutions and the associated savings were paramount in their decision.