How Biologics by McKesson Lowers Healthcare Costs
Biologics by McKesson specialty pharmacy is payers’ best ally in our shared goal of lowering costs and burdens to the healthcare system.
As chronic disease rates continue to increase, specialty therapies that require complex, long-term and often very costly treatment plans are flooding the market, and the cost of healthcare is rising.
Under these complex treatment plans, nonadherence rises too. This ultimately leads to adverse events that are costly to both patients and payers, who often try to contain healthcare costs by simply ratcheting down reimbursement.
Payers often do not have clear line of sight into the true costs of care due to systemic healthcare silos and the general lack of visibility between pharmacy and medical benefits. It’s difficult for payers to know if the costs of the claims they are paying were justified, necessary or avoidable — or if there was a better option.
Under this current system, it’s not always easy for payers to see how value-based care more effectively lowers overall healthcare costs, and they may not realize specialty pharmacies can be their best ally in containing costs.
Biologics by McKesson is trying to change that. Payers are not alone in the important work of reducing cost to the healthcare system and making the system sustainable.
As a specialty pharmacy, Biologics does much more than distribute specialty therapies. It works with payers to provide needed visibility while working with patients and providers through proven methods to optimize treatment plans, which ultimately benefits all parties — including payers — by creating efficiencies, increasing adherence and reducing costly adverse events.
Biologics shares payers’ goal of lowering healthcare costs. Its proactive and customized patient-support services are proven to not only promote better patient outcomes but also lower costs.
Proven Cost-Saving Techniques
- Cycle management
- Dose management
- Address compliance challenges
- Refill Reminders
- Pill counts
Effective, Clinically Expert Care
- Deep clinical expertise promotes efficient use of the healthcare system
- Differentiated access to oral therapies that allows continuity of care as patients progress from one treatment to another
- Careful and effective patient care coordination and management to mitigate escalation of serious side effects and prevent related hospitalizations or ER visits
- 86% enrollment in patient-support services
- Best-in-class patient satisfaction ratings
Broad Payer Network
Contract coverage that allows Biologics to support patients in all segments, under Medicaid, Medicare and commercial insurance
Deep Therapeutic Range
cancer and complex-care therapies
Personalized Care Team Facilitates Reduction of Hospital Stay
Biologics lowers costs by working closely with patients and providers to reduce hospitalizations and hospital stay.
A 75-year old-female on a third-line treatment for ovarian cancer.
The patient was hospitalized for shortness of breath.
The patient’s Biologics Care Team of pharmacists and nurses were the first to learn of this event. We promptly created a care plan regarding shortness of breath, educated the patient and informed the healthcare provider’s office. During the patient’s hospital stay, we worked closely with the oncologist and hospital discharge planner as part of the patient’s caregiver team to get the patient well enough for discharge as quickly as possible, eliminating a long hospital stay and the potential for further complications. After hospital discharge, we continued to engage with the patient regularly and manage her case holistically to prevent the need for further hospitalizations.
Due to our enhanced risk-based care plan, the patient’s hospital stay was reduced by 4 days. The patient shared that she wants to continue to participate in our patient-support services “because it helps me so much to have you to talk to.”
$16,000, or the cost of a four-day medical-surgical hospital stay (averaged at $4,000 per day), plus the unknown but significant cost of further complications.
Individualized Care Plan Makes Healthcare Use More Efficient
Biologics lowers costs by supporting patients with assistance not always available from their providers, avoiding unnecessary testing and office visits.
A 73-year-old female on therapy for a malignant neoplasm of the right ovary.
During a routine scheduled call, the patient’s Biologics Care Team learned that she was experiencing side effects in the form of painful mouth sores, decreased appetite and fatigue.
The patient’s Care Team developed an individualized care plan to address her side effects. For mouth sores, the nurse recommended rinsing with 8 ounces of water and 1 teaspoon of baking soda and/or salt every 2-3 hours and using Orajel or another mouth sore-specific mouthwash. For decreased appetite, the nurse recommended grazing and eating small meals every 2-3 hours instead of large meals, eating high-protein and high-calorie foods, and taking supplements if needed. For fatigue, the nurse recommended planning ahead, organizing work, pacing herself and her activities, and scheduling rest periods throughout the day so as not to overexert herself. The nurse also reassured the patient that these are known side effects of the therapy that many patients experience at first but that often resolve over the first few months as the body adjusts to therapy and the patient continues with the mitigation techniques. The Care Team encouraged the patient to call if she ever had any questions or concerns, and they confirmed a follow-up call in 1 week to assess improvement of the symptoms. The Care Team also notified the patient’s oncologist.
It was important to catch these symptoms early, and because of the Care Team’s clinical expertise, they knew to look for them. A grade 3 or 4 side effect of mouth sores would have made it much more difficult for the patient to swallow pills and could not continue to take the medicine. Therefore this early intervention was crucial in keeping the patient adherent.
$600 in unbilled medical care provided by the specialty pharmacy nurse that drove better compliance and avoided unnecessary medical spend associated with treatment of serious side effects or disruption of treatment.
Change in Dose Allows Patient to Stay Adherent
Biologics fills communication gaps between patients, providers and payers and works to optimize dosage to avoid disruption of treatment.
A 60-year-old female on therapy for malignant neoplasm of endometrium.
The patient called her Biologics Care Team to report high blood pressure and was subsequently admitted to the emergency room. Eight days later, the patient called again and stated that she needed to push her refill date out since the medication had raised her blood pressure.
The Care Team advised a dose change to counteract the side effect and help the patient remain adherent. When the patient requested to push out her refill date, we contacted the patient’s medical doctor’s office (MDO) to discuss a change in dose, and the MDO provided a verbal prescription change. As a result, the patient received a reduced dose from 20 mg daily to 14 mg daily.
The patient’s reduced dose allowed her to manage her blood pressure without disrupting continuation of treatment. In this case, if the patient had not had regular check-ins with her Biologics Care Team, she may have become nonadherent without her MDO knowing.
$1,400, or the cost of an emergency room visit, plus $600, or the cost of an MDO visit with a specialist, plus the unknown but significant cost of nonadherence.
Effective Cycle Management Prevents Medication Waste
Biologics pharmacists perform pill counts to avoid noncompliance or overcompliance, prevent waste of medication and optimize refills.
A 74-year-old male on therapy for a gastrointestinal stromal tumor.
The patient received a dispense of 56 tablets and then four days later received a dose change. Due to the dose change, the patient now had a two-month supply on-hand.
The patient’s Biologics Care Team took note of this and, instead of dispensing again the next month, dispensed another 28 tablets after two months. In addition to regular nurse check-ins, Biologics has a certified pharmacy technician call patients before their next refill is due to perform a pill count and high-level survey, so regardless of whether the patient had reached out, Biologics would have caught the problem before it arose.
The delayed dispense of the drug due to the patient’s supply on hand ensured that no pills would go to waste and no refills would be paid for unnecessarily. Without Biologics’ knowledge of the patient’s case, the pharmacy may not have known about the dose change and the payer would have overpaid for the patient’s over-dispense.
$23,000, or the cost of two month’s supply of the drug (averaged at $11,500 per month).