Elevance Health PBM debuts specialty pharmacy savings tool

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CarelonRx, Elevance Health's pharmacy benefits manager, is debuting an analytics tool that aims to make it easier for employers to plan for future specialty pharmacy costs while providing advocacy to employees who utilize specialty medications.

The SpecialtyRx Savings Navigator, which uses advanced analytics, will identify members whose health is at the greatest risk. Once identified, this sparks a review of a member's clinical diagnoses, medications, whole-health integrated support and a review of their site-of-care options.

Members will then receive pharmacist-led outreach to address barriers to care, and to further coordinate integrated care with their whole health team, including medical and behavioral health professionals.

Specialty medications, which treat complex illnesses, will represent 43% of global medicine spending by 2027, according to IQVIA.

WHAT'S THE IMPACT?

For employers, the tool provides disease-specific forecasts to help plan for future drug spend projections and budgeting; recommendations for optimized plan design, benefit and product solutions; and customized member support to reduce costs and optimize spend through medical rebate sharing.

Michele Paige, vice president of product and digital strategy at CarelonRx, said the offering "will also give employers the peace of mind in knowing their employees who are battling complex and chronic conditions are receiving personalized support, and it will give employers better insights into how best to budget for future specialty spend for their business."

The tool is one of a few ways CarelonRx is emphasizing support for members living with complex illnesses, and expanding its footprint in specialty pharmacy.

For instance, Elevance Health recently acquired Paragon Healthcare, a company specializing in infusible and injectable therapies. The company also intends to acquire Kroger Specialty Pharmacy this year.

Last year, Elevance Health acquired BioPlus, a company that provides a range of specialty pharmacy services for patients living with complex and chronic conditions, such as cancer, multiple sclerosis, hepatitis C, autoimmune diseases and rheumatology.

In 2024, CarelonRx will open three additional BioPlus Specialty Pharmacy dispensing centers in Chandler, Arizona; Indianapolis; and Raleigh/Durham, North Carolina; as well as four non-dispensing pharmacies in Las Vegas; Denver; St. Louis; and Indianapolis.

THE LARGER TREND

Elevance Health announced the launch of healthcare services brand Carelon in June 2022. Carelon services range from research to integrated whole person care delivery, pharmacy, behavioral health and digitally enabled solutions.

This spring CarelonRx will launch a weight-management program to provide support to members who are on weight loss journeys – including those who use GLP-1 medications. The digital-first program will provide access to digital coaching and wellness tools meant to help participants manage and monitor their weight goals, with the ability to connect to live human support, both digitally or over the phone.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.