AllianceRx Walgreens Pharmacy: A Payer’s Best Specialty Pharmacy Partner
At AllianceRx Walgreens Pharmacy, we understand our payer partners are interested in having the best possible outcomes for their members, with an eye toward keeping costs down and reducing the overall drug spend. In this article, we will discuss solutions we offer payers, key benefits of these solutions, and introduce you to our Specialty360 therapy teams, which underscore our commitment to patient care.
Support for High-Cost Specialty Trends
We bring a proactive, predictive, and consultative approach to your specialty trend management and program success. We act as your specialty pharmacy team of advisors. Through our dispensing platform, our reporting/analysis team, and our cloud-based payer portal SpecialtyScope, we provide access to real-time insights and suggestions. This helps identify and get ahead of potential spend accelerators and new drugs and trends that drive costs at the group and disease state levels.
Our experienced clinicians – including our Specialty360 therapy teams – use a condition-specific focus that integrates a center-of-excellence approach with modern patient engagement technologies. This helps ensure patients start therapy on time, adhere to therapy, and receive the maximum therapeutic benefit. Through our Connected Care® clinical support and clinical audit programs (CAPs), we look for ways to reduce costs while maintaining outcomes.
These programs serve as a safety net to your pharmacy benefit manager (PBM) programs, giving you a second level of oversight. Our trend management guarantees help ensure your return on investment in clinical partnership with us. We guarantee 100% execution of CAP criteria and assume all risk when we don’t deliver. Our programs provide a detailed view and collaborative approach to managing, reversing, and preventing high-cost specialty trends to your budget.
Outcomes-based Arrangements
Specialty drug spending is now 44% of total drug spend and is expected to reach 52% by 20241. A large factor driving this area is gene and cell therapy. While the high, mostly one-time costs of these treatments may offset ongoing therapy costs, payment models will likely present a challenge to payers.
AllianceRx Walgreens Pharmacy works closely with pharmaceutical manufacturers and our payer partners to explore value and outcomes-based contracting. This approach brings together two key stakeholders – payers and biopharmaceutical manufacturers – to expand alternative payment models specific to gene therapy and other high-cost treatments.
Our gene and cell therapy solution provides holistic care throughout a patient’s entire healthcare journey. This approach includes delivering products and solutions to all stakeholders. We are also aligning with our pharmaceutical manufacturer partners to explore value-based outcomes for payers regarding efficacy of treatment.
The benefits of value-based contracts include:
• More efficient pricing mechanisms
• Manufacturer ability to differentiate and demonstrate the effectiveness of their product versus their competitors, which can assist payers in making formulary decisions
• Payer ability to use value-based contracts to gain experience with a product
Further Considerations
As an additional layer, research2 now shows that 80% of patient clinical outcome is based on non-clinical factors, namely conditions in the environment in which people live, learn, work, play, worship, and age – known as social determinants of health. At AllianceRx Walgreens Pharmacy, we practice whole-person care and make efforts to intervene in these social factors, removing barriers and allowing patients the opportunity to focus on their healthcare.
Healthcare costs will continue to rise, in part due to specialty trend. We work closely with our payer partners to evaluate and implement several total cost-of-care solutions aimed at managing long-term drug spend. When you combine our enterprise scale – i.e., AllianceRx Walgreens Pharmacy and Walgreens (community-based specialty pharmacies and specialty at retail) – with current products and services, you will find our solution is unique in its multi-faceted nature.
Moving forward, we will continue to develop and implement reimbursement strategies and programs that are innovative and provide access to the newest treatments that come to market. This will help ensure payers can afford those treatments for their members while keeping their benefit affordable and sustainable.
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