Quantum Health makes push to streamline pharmacy navigation
Its specialty pharmacy capability includes utilization management and a site-of-care program combined with in-house pharmacists.
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Healthcare navigation and care-coordination company Quantum Health has expanded its specialty pharmacy services with a new Premier Pharmacy navigation offering aimed at employers.
Premier Pharmacy leverages the expertise of an in-house clinical pharmacy team – which advises members on cost-effective care under their medical benefit – to now also guide people to cost-effective, clinically equivalent alternatives under their pharmacy benefit, the company said.
The offering is built on the company's core navigation and existing specialty pharmacy capability, encompassing more than 500 self-insured employer clients and over three million members.
Its specialty-pharmacy capability includes utilization management and a site-of-care program, combined with its in-house pharmacy services team comprising doctors, pharmacists and analysts.
The care team then collaborates with providers to direct members to curated options to ensure that the treatment is optimized clinically and financially through a tailored, educational process.
The offering's key features include member identification using claims, formularies and clinical criteria; value-based intervention via therapeutic alternatives for specialty medications; member education and support; and provider/prescriber outreach.
WHAT'S THE IMPACT?
Prescription medications remain the fastest-growing component within employee health benefits, with specialty drugs rising by more than 10% in 2023, according to Mercer's 2023 National Survey of Employer-Sponsored Health Plans. Industry estimates point to approximately 50 new specialty drugs entering the market this year, and controlling drug costs will continue to challenge employers and their employees.
In the MedCity News and Quantum Health annual benefit consultant survey, 28% of healthcare benefits consultants reported they are recommending pharmacy spend management to improve employers' healthcare spend, and 61% of consultants are advising clients more often on drug cost and pricing strategies.
A 2023 study of over 200 Quantum Health employer clients and 1.8 million members found that the use of the company's navigation platform achieved a 91% success rate in shifting the site of care for members' specialty drug treatment.
THE LARGER TREND
Specialty medications account for more than 50% of prescription drug spend in the U.S. due to the increasing prevalence of chronic disease.
Walgreens said in April that it would be expanding its specialty pharmacy services, while Elevance Health debuted a new 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. Meanwhile, an Elevance Health subsidiary, CarelonRx, is set to acquire grocer the Kroger Co.'s specialty pharmacy business.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
