a Second Opinion on High-Cost Medications
Utilizing Cost-Effective Medications Is at the Core of What We Do
Right
Drug
Right
Patient
Right
Outcome
Too Much Trust...
Too much trust has been placed in our healthcare system. We assume that by the time a medication gets to the patient, it is the best choice and the lowest cost option.
Often, a more effective and lower cost drug could be used to achieve the health outcomes we want for our patients.
We've Seen Our Healthcare System Fail, Time and Time Again...
As practicing pharmacists, we’ve seen the gaps in traditional care and the failure to achieve optimal drug management, from provider to PBM to pharmacy. Failure to optimize drug management, by using the most evidence-based and cost-effective drugs, has detrimental financial effects on health plans. Furthermore, the current system leaves patients navigating a confusing and transactional healthcare process, with very little guidance.
Providers
Providers have limited time with patients, which often results in the prescribing of expensive medications
PBMs
PBM guided prior authorizations and step-therapy are far from true clinical management
Pharmacy
Dispensing pharmacists have busy workloads and only have time to prioritize drug safety, not clinical outcomes
CUTS
OUT
HIGH
COST
DRUGS
YOUR
MEMBERS
DON'T
NEED.
PERIOD.
Idenitfy High-Cost Medications
All members may pay the same premiums but their cost of care can vary significantly.
Using claims data to find members using high-cost drugs, gets to the source of who is driving up your pharmacy spend.
Clinical Second Opinions
We get second opinions on so much in life, car & home repairs, surgery, etc.
Why not on costly medications?
Our clinical pharmacists' second opinions ensure members are using only the most cost-effective medications.
Upstream Management
Simply plug us in upstream of your pharmacy related vendors (PBMs & Alternative Funding Programs).
Medications we've deemed as necessary can flow downstream to these vendors, who can find the best price and rebates.
How We Make Health Benefits, Better!
The Health Plan
Your team can focus on other business operations, knowing you're only paying for cost-effective drugs; helping you avoid big premium increases and siphoning business dollars for healthcare expenses.
Health Plan Members
Members are now on the most cost-effective regimen and can expect optimal health outcomes, lower out-of-pocket costs, greater productivity and an overall better quality of life.
Prescribers
Prescribers now have help in making cost-effective, evidence-based treatment decisions. This frees up time for other important aspects of care, which are often neglected due to time constraints.
Pharmacy Benefit Managers (PBMs)
Now that we've identified the ideal medications for your members, your PBM can negotiate the best price and rebate on behalf of the plan.
Alternative Funding and International Sourcing
Once high-cost drugs have been identified as necessary, the plan can consider acquiring the medications from less traditional sources.
Managing Prescription Drug Costs Is a Top Priority for Most Employer Sponsored Health Plans
High-Cost Drugs We Commonly Discontinue, Substitute or Deescalate:
How Does it Work?
Collect
We collect the member’s data from the health plan.
Compare
We compare the member’s data and medical history with their current medications.
Correct
We correct the member’s drug regimen in coordination with their healthcare providers, to ensure they’re taking only the right medications; marrying low costs with the best health outcomes.
Working With Apothicor Wellness is Simple:
No Plan Changes.
No Carrier Changes.
No Formulary Changes.
Let's Reimagine What Clinical Can Do!
Innovative brokers are willing to evaluate opportunity and tailor healthcare solutions to the needs of their clients’ members. High-cost medications hurt premium renewals, including stop-loss. Pharmacy claims now eclipse 25-30% of total healthcare spend, a percentage that is projected to continually grow for the foreseeable future.
It’s time to get serious about the 20% of drugs that are driving 80% of your clients’ pharmacy costs.
High-cost drugs are at the core of what’s driving healthcare beyond affordable.