Mitigating trend effects with new programs and strategies
Last year, CarelonRx launched new clinical programs that resulted in an estimated $750 million in incremental savings.
Trend mitigation strategies included, but were not limited to:
- Evidence-based formularies and clinical edits
- High-touch member outreach
- Cost-management strategies
- Utilization and channel management
- Pharmacists partnering with providers
What about the specialty space?
On the specialty side, combined utilization and channel management strategies delivered savings of over $300 million — $453 per utilizing member per year. Clients that used our full suite of clinical-management strategies spent an average of $2,639 less in drug costs per member per year compared to those that did not.
In particular, focus was placed on oncology solutions, knowing that cancer care has a big impact on healthcare. CarelonRx’s oncology initiatives generated approximately $41 million in incremental savings. For a member with cancer, that meant nearly $1,100 in additional annual savings.