HBCH Specialty Pharmacy Specialty Waste And Trend Analysis Program

Making specialty drug spend more transparent for actionable management.

Summary: An employer-specific analysis of specialty drug spend to identify waste and inappropriate use across both pharmacy and medical benefits, providing focus on highest priority areas to manage for cost and quality.

​Specialty Pharmacy spend continues to be one of the fastest growing budget items in an employer’s healthcare benefit.  Multiple challenges exist to keep employers from managing this important but costly category, namely

  • Extreme high prices per total courses of therapy
  • Complicated therapies for life-altering diseases
  • Disparate definitions of “value” making identification of inappropriate use difficult
  • Lack of actionable and transparent information
  • Siloed vendors and conflicting interests between them
  • Time and expertise to manage this category

And looking forward, the trend for specialized therapies will only continue.

Recognizing the need for better and more actionable data to help employers build specialty pharmacy management strategies, HBCH has partnered with ArchimedesRx, http://archimedesrx.com/, to offer their clinical pharmacy analytics called Specialty SWAT AnalysisTM to help HBCH employers identify areas of opportunity to improve their specialty spend.

Ongoing Results: In 2018, 5 pilot employers recognized in aggregate a near-20% reduction in spend ($5.2 mm) opportunity.  HBCH facilitated all aspects of this project.

Here is what some HBCH Employer members have said;

  • “…even if we experience half of the saving that is still a 5:1 ROI.”
  • “I have learned a lot, and this will help me push my vendors to get the most out of my plan.”
  • “We saved $20,000 with one phone call.”

As of Q3 2019 an additional 4 employers have used the Archimedes program to dig deep into their pharmacy data and find actionable areas to save money.  All SWAT participants have recognized a minimum of a 20% cost reduction opportunity. 

SWAT is an ongoing offering through HBCH with our partners Archimedes. Fees are discounted through the coalition and are based on member lives.  If you would like to take advantage of this program, reach out to Chris Skisak at [email protected] for more information.