Chelko uses our unique clinical and sourcing expertise to dramatically reduce drug benefit costs for plan sponsors and improve member care. While others mistakenly chase discounts and rebates, we focus on removing waste and excessive profiteering from plans and helping members more affordably get the medications they need.
The fact is, too many people are using old strategies to take on new challenges. While brand and generic medications make up almost 99% of total prescriptions and have long been the primary focus of most cost reduction efforts, it’s more than time to shift our attention to the other 1%.
It has become abundantly clear that specialty drugs ― especially new cell and gene therapies ― are driving drug and medical benefit costs. What used to be 10% of drug benefit spend is now about 50%. On top of that, almost a comparable amount of high-cost specialty drug spend is hidden in medical benefit programs.
That’s why we’re flipping the script and tackling the toughest jobs first. We are talking about the high-cost outliers. The most expensive of the most expensive and the bulk of medications in PhRMA’s development pipeline.
Instead of following the pack by continuing to chase discounts and rebates, we go to where we can have the greatest impact. Our upside-down approach helps clients break away from the volume-driven sourcing model that just doesn’t work for managing high-cost claims.
Introducing Value-Based Drug Management
Drawing on an in-depth knowledge of both prescription drug and medical benefits, Chelko’s team of pharmacists and consultants employ a custom combination of proven strategies to reduce cost without adversely impacting member experience or quality of care.
The medical needs and care of high-cost claimants are very different than other plan members. If not carefully managed, millions of dollars can quickly vanish.
The key is to adopt a thoughtful, clinical sourcing approach for specialty claims ― asking the right, often hard, questions and having the proper expertise to act appropriately on the answers.
It also means interacting with providers and patients in such a manner that gives them confidence that the patient is getting the right amount of the right drug at the right time and for the best price possible.
And while our Value-Driven Drug Management approach starts with tackling the toughest claim issues, that’s not to say we ignore volume-driven sourcing. Far from it.
Our pharmacists and consultants have successfully achieved 15% – 30% savings for our clients by paying close attention to every aspect of a plan’s drug spend from top to bottom ― all while maintaining an unwavering commitment to providing better care.