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July 15, 2007
NGS Adds PrecisionRx Specialty Solution
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NGS is pleased to announce the addition of PrecisionRx Specialty Solutions of WellPoint to the services available to NGS clients effective August 15, 2007. PrecisionRx is a full-service specialty pharmacy and support program to more effectively manage and monitor the distribution and effectiveness of specialty drugs. The addition of PrecisionRx will aid clients in the controlling their plan's costs while enhancing member services and medication safety.
What are Specialty Drugs?
Specialty drugs are the fastest growing segment of prescription drug costs. These medications (used to treat people with cancer, infectious diseases, AIDS/HIV, heart disease and many other conditions) are used by only 1-3% of a group's population, but can account for as much as 30-35% of a plan's costs. These medications are frequently billed through the patient's physician and paid under the medical plan, rather than through the PBM, and may receive minimal network discounts when delivered through a physician. Annual costs can range from $18,000 to $350,000 per patient (compared to about $550 per patient for "traditional" medications). Clearly, this portion of plan expenses, for most employers, needs additional attention.
How is PrecisionRx Able to Save on these Drugs?
The PrecisionRx program produces better financial results through both deep discounts and managing clinical outcomes for members taking specialty drugs. They are able to leverage the drug spending of over 34 million members to obtain "best in breed" pricing for clients based upon an average wholesale price as opposed to physician office pricing which may be multiples of average wholesale price. Distribution methods assure that the right medication is available at the right time without spoilage or waste. Additionally, individualized care coordination assures adverse reactions/events are minimized, adjunctive therapies are appropriate, and the patient is regularly assessed for pain management, fatigue, nutrition, comorbidities and other complications.
How does the PrecisionRx Program Work?
On a weekly basis, NGS will provide a data file to PrecisionRx. Based on paid claim data, PrecisionRx will reach out to the prescribing physician to arrange providing the specialty medication directly from Wellpoint's pharmacy. After physician consultation and agreement, a Clinical Care Coordinator will contact the patient. From there, the physician, pharmacist and patient will work together to manage the patient's medication and condition. PrecisionRx services include:
- One on one service from a Clinical Care Coordinator,
- Educational material and discussion with the Clinical Care Coordinator on any potential side-effects,
- Assistance to the physician to ensure issues (such as off-label) is resolved prior to the drug being prescribed and administered.
- Provision of supplies (syringes, needles, etc.) at no additional cost,
- Proactive follow-up calls to ensure medication is being refilled in a timely manner and that prescribed regimens are being followed.
What Does the PrecisionRx Program Cost?
There is no cost unless PrecisionRx is able to impact plan costs. All fees are on a contingency basis - thirty (30) percent of savings off average wholesale price capped at $2,500 per drug claim.
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The Patient Protection and Affordable Care Act of 2010 
