BERWYN, PA — AscellaHealth, a national specialty pharmacy benefit manager serving commercial, Medicare and Medicaid segments, announces a new specialty medical benefit strategy designed to drive significant outcomes for employers and third-party administrators (TPAs) and proven to deliver full transparency on specialty drug spending and overall utilization. With approximately 50% of the specialty drug spend occurring in the medical benefit and a variety of payment and dispensing options, this strategy provides the strategic guidance, integrated technology and clinical pharmacy programs to transform medical benefit pharmacy spend into a cost-effective benefit model.
“Specialty drugs play an increasingly important role in the treatment of chronic conditions, such as multiple sclerosis, rheumatoid arthritis, immune deficiency, hemophilia and cancer, but little is known regarding the comprehensive medical benefit utilization and cost trends for these conditions,” says Dea Belazi, president and CEO, AscellaHealth. “AscellaHealth medical benefit strategy can drive significant outcomes for organizations by opening up an innovative avenue for gaining complete transparency.”
Other key benefits include:
- Lower pharmacy cost
- Better contract terms
- Accurate forecasting, modeling and planning for the future
- Automated delivery and integration of benefit claims
- Enhanced information management and refined analytics
These advantages enable licensed pharmacists to offer recommendations and implement custom clinical programs based upon the plan sponsor’s unique patient population.
By carving out medical pharmacy benefits, plan sponsors create the potential to save 20+ or more annually on benefits costs, with fewer emergency room visits and hospitalizations. Medical integration also helps reduce therapy medication optimization by curbing waste and inappropriate prescriptions, including incorrect dosage. AscellaHealth’s experience in containing costs aligns with industry standards, which show an estimated $250,000 in savings could be achieved in one year with a single disease category carve-out. Implementing site-of-service management can save between 12% and 34% – up to $1.8 billion nationally per year.
Belazi adds, “Our goal is to create innovative solutions that streamline healthcare delivery and benefit management for specialty, which is why we have sorted the various benefits of a PBM carve-out so that plan sponsors can engineer a plan that works best for their clients.”
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