Evernorth Medical Drug Management
Evernorth Medical Drug Management delivers a robust suite of strategies for specialty medications within the medical benefit. Our tools maximize savings for plans, reduce gaps in care, enable cost-effective clinical decision making and minimize administrative demands for physicians.
How are you leveraging pharmacy and medical drug expertise to address the impending tsunami of medical specialty drug costs?
The rise of complex, chronic conditions are driving up specialty drug use and costs to record numbers. This spend will only continue to increase over the next three years, with 200 specialty drugs set for approval. Fragmented, disconnected drug management strategies can lead to wasted time and resources, missed opportunities, and more work for health plans.
40% of specialty drug spend occurs on the medical benefit.1
As more drugs are administered in doctors’ offices, clinics or through home or hospital infusion, traditional specialty drug trend management tools must be leveraged on the medical benefit side to ensure patient safety and to eliminate waste.
With over 30 years of experience as a PBM, and over 25 years of Specialty Pharmacy (Accredo) experience, you can be assured our advanced clinical knowledge and organizational expertise will deliver a best-in-class review process that catches overspending that could otherwise easily be missed.
1. 2019 PBMI Specialty Drug Benefit Report
Savings Guarantee
Evernorth's Medical Drug Management program offers clients a minimum savings guarantee, with an average client savings of $8 PMPM2.
2. Medical Drug Management BoB Data CY 2021
Simply relying on prior authorizations alone can leave room for significant financial loss.
Before paying medical drug claims, many health plans ensure an approved prior authorization is present—however many systems end there.
The complexity behind specialty drug claims and the lack of system automation can often mean that the majority of medical drug claims are not checked for common errors including inappropriate billing codes, administration service codes, and drug waste.
Plans with utilization management in place but no payment integrity or dose management protection spend an estimated $5.99 PMPM more than plans that validate claims prior to payment.3
3. Medical Drug Management BoB Data CY 2021
Leading the Industry in Managing Drug Trend
PMPY projected savings for commercial plans8
8. 2020 Medical Drug Management BoB Data – QBR Savings Evaluation
Average savings for each site of care redirection9
9. 2019 Medical Drug Management Site of Care Program Performance – Client Quarterly Business Review
Minutes saved per case with automated self-service offering10
10. 2020 ESI Clinical Ops evaluation, examining OnePA system medical drug reviews compared to manual reviews of a clinician referencing clinical policy documents
Average savings from clinical protocols to ensure no waste and therapy appropriateness11
11. Medical Drug Management BoB Data CY 2022