Case Study: Managing High Cost Medications

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Pharmacy benefit managers (PBMs) and specialty pharmacies can vary in the quality of clinical services provided in managing patients, who have complex medical conditions and receive high cost medications.

  • Emerging models of care place great emphasis on care coordination between the patient and multiple stakeholders involved in the patient’s medical care. 
  • Care coordination links all of the patient’s medical service providers to ensure active dialogue, effective communication, monitoring of service delivery, prevention of redundant services, and identification of gaps in care – all with the intent of achieving better health outcomes and judicious use of health care dollars for these patients with complex medical needs. 

The following client case study describes the assessment of clinical services performed by a national PBM’s specialty pharmacy that led to improved quality of care and reduced cost. The assessment was conducted by our national PBM practice.