Transparent operations, nimble technology and clinical expertise enabled Virginia Premier to improve opioid utilization, member care and their bottom line.

SITUATION 

Virginia Premier Health Plan (VPHP), a managed care organization owned by the Virginia Commonwealth University Medical Center, serves 200,000 vulnerable population members in Virginia by delivering quality-driven, culturally sensitive, and financially viable healthcare.

An EnvisionRx client since 2012, VPHP required a partnership with a pharmacy benefit manager that could help them navigate their complex environment, reduce costs and deliver a better pharmacy care experience for their members.

Rising Specialty Costs & Increased Market Complexity
The high cost of specialty medications has changed the landscape of pharmacy care. Since 2010, specialty medications have dominated new drug approvals, and at the same time, increased drug spend considerably.

But cost is only part of the concern. Health plans like VPHP have to determine if these new drugs are effective, safe and the best treatment for the member. Rebates and new formulations of previously approved drugs are inflating drug spend, and causing confusion in the marketplace. Each situation has to be carefully weighed to ensure the right decisions are made in regards to pharmacy care.

Lack of Pricing Clarity
Amidst the complexity of rising drug costs, manufacturer rebates and discounts, VPHP wanted visibility into the true cost of the prescriptions their members need. They wanted better access to utilization data, network contracts, and manufacturer rebate contracts with the ability to audit down to the individual claim. 

Complex Drug Pipeline & Need for Additional Clinical Insight 
As more and more drugs enter the marketplace, VPHP wanted assistance understanding and balancing the clinical effectiveness, economic impact and member benefit for new-to-market and existing medications.

Emergency Opioid Regulations 
When the State of Virginia prioritized the problem of opioid addiction, VPHP needed a partner with the infrastructure, resources, and flexibility to meet new requirements and provide data to proactively address the epidemic from within the member population.

OUTCOMES

Transparent Operations and Pass-Through Pricing Model Yield Savings of $42M

Compounded Medication Approach Saves Plan $840K, Making HIV Adherence More Affordable

Custom Reporting Predicts At-Risk Pregnancies, Saving Money and Lives

Improved Drug Pipeline Management from P&T Partnership & PBM Clinical Perspective 

Compliance Requirements Met; $370K in Savings from Reduced Opioid Use