High-Cost ≠ Quality Care

Clinical, for the win!

Instead of asking “how much does it cost and how much rebate?”

We’re asking “why this drug?”

Specialty drugs represent only 2% of all prescriptions but account for nearly 50% of total pharmacy spend.

Brand name drugs (including branded specialty) represent only 20% of all prescriptions but account for nearly 80% of total pharmacy spend. 

Negotiated costs and rebates only matter for drugs your members actually need; let’s focus on the need of these high-cost drugs first! 

We curate an individualized and evidence-based treatment plan with each participating member. Every therapy change we advocate for, is a more cost-effective approach than what’s currently in place and NEVER hinders patient’s health outcomes.  

Discontinue

We determine if the currently prescribed high-cost drugs are absolutely necessary to achieve optimal health outcomes.

Clinical data, patient history, labs and health conditions are all weighed to determine a drug’s necessity. 

 

Substitute

When high-cost drugs aren’t required for optimal health, our team of pharmacists identify opportunities to replace them with more cost-effective therapies. 

We are confident these recommendations will achieve the same outcomes as the previous high-cost drug.     

Deescalate

When a high-cost drug is necessary to achieve ideal patient outcomes and substitutions are inappropriate, we identify ways to reduce therapy burden when supported by quality evidence. 

This includes reductions in drug dose and frequency of administration.

 

Incentives

The biggest question employers have about health plan vendors is, “how do I get my employees to participate?” 

Incentivizing employees to be proactive about their health is no easy task. Studies suggest it takes at least $50 to get employees just to participate; however, the results employers are looking for require incentives well over $200. Normally, this is too costly for employers because there is no guaranteed return on investment. The lack of participation means even the best services are destined for failure. 

At Apothicor, we have developed an incentive strategy that is unique to our ability to clinically reduce drug spending. This allows plans to offer significant financial incentives to members while producing predictable returns on investment. 

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Frequently Asked Questions:

What Should I Expect When Participating?

When you choose to participate, we’ll schedule an appointment. During this appointment we’ll:

  1. Improve your understanding of your health conditions and how your lifestyle choices can impact them.
  2. Educate you on your medications and identify medications that could further help you meet your health goals.
  3. Identify opportunities to continue to manage your health conditions using more cost effective medications.
What Is the Cost to Members to Particpate?

There is no cost to members for participation. The cost of the program is covered 100% by your health plan through drug savings.

Who is Eligible for These Services?

Only members of the contracted health plan with eligible health factors can participate. If eligible, you will receive notice from your health plan and Apothicor Wellness.

If I'm Eligible, Is Participation Required?

There is no penalty for not participating. However, participating could provide incentives which considerably reduce your healthcare premiums or out-of-pocket costs. 

Are You My New Healthcare Provider(s)?

No, we in no way replace your current healthcare provider(s). Instead, we integrate with your care team to assist treatment decision making and augment the care you already receive. 

If Eligible, How Do I Particiapte?

Once you or your dependent has been notified as eligible you’ll need to:

  1. Complete the HRA (Health Risk Assessment), found on the “Forms” section of this website. A link is provided in the email you received notifying your eligibility.
  2. Sign our privacy policy and patient consent forms, both will be emailed for your signature upon completion of the HRA.
  3. A member of our staff will schedule an appointment with you.
  4. Meet with our pharmacists to understand more about your health conditions, medications and ways to optimize your care.
  5. Reach out with questions via text when needed and we’ll continue to follow up monthly to monitor your progress. 
How Do I Meet With Apothicor's Staff?

All of our services are done via telehealth through secure, HIPAA compliant video communications. 

What Incentives Are Available?

The amount and type is determined by your health plan, in accordance with rules and law regarding wellness programs. Cash benefit, premium reductions and waiver/reduction of deductible are ways incentives are commonly provided.

Included Services