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Improving Cost and Outcomes in Pharmacy Care

Elevance Health Impact March 29, 2021

Rising medication costs and medication nonadherence continue to frustrate health plan sponsors and members alike. To address these and other concerns, we built CarelonRx, a modern, integrated pharmacy benefits manager.

Following the successful migration of 16 million members to CarelonRx, we are on course to realize a new future for pharmacy care – an innovative and technology-led experience, with greater access and affordability, that benefits sponsors and members.

Shaping The Future of Pharmacy Care with an Integrated Model

Improving the pharmacy experience and achieving better health outcomes is personal for Fizza Khan, a pharmacist with CarelonRx's Diabetes Polypharmacy Program, designed for members with diabetes who take more than 10 medications.

In one case, while conducting a comprehensive review of medical pharmacy claims, she discovered a member was taking metformin to control high blood sugar. She learned he had chronic kidney disease, a condition for which metformin can be dangerous. She also discovered that the member was not filling prescriptions to treat his cholesterol, blood pressure, and diabetes.

“I contacted the member’s physician right away and recommended discontinuing the metformin, as well as addressing the importance of adherence for the member,” Fizza explained. “By being able to see a more complete picture of the member’s health, I not only prevented a potentially serious medical emergency, I also set him on a path to better health through medication adherence.”

By integrating medical and pharmacy data, we close gaps in medication therapy while lowering costs. CarelonRx sends more than 3 million care gap messages to members annually, which contributed to a 41% increase in member medication adherence. This approach specifically enabled plan sponsors to share in more than $32 million in pharmacy savings and $119 million in averted medical costs. Individually, clients of our health plan affiliates are seeing an average decrease in medical costs of $30.70 per member per month over plans with carved-out pharmacy benefits.

This modern approach is getting noticed. CarelonRx launched a partnership in 2020 with Blue Cross of Idaho to provide pharmacy coverage for its commercial and Medicare members. In 2021, CarelonRx is also providing pharmacy coverage in partnership with the largest government health plan in Hawaii, AlohaCare.

Reimagining the Retail Pharmacy Experience

Like Fizza, Stu Libby was also propelled by family health circumstances to reimagine the pharmacy experience. Stu is the co-founder and CEO of ZipDrug, which he founded more than five years ago after his father had a life-threatening cardiac event. When his father was discharged from the hospital without his medications – leaving him to coordinate his post-hospital pharmacy care on his own – Stu realized he could save lives by simplifying the retail pharmacy experience for patients.

“Imagine when you arrive home after your doctor visit or hospital stay and your prescription is already there. Or, if you are managing chronic conditions, you get a monthly delivery from your local pharmacy with the daily doses of your medications conveniently sorted,” said Stu. “ZipDrug creates a new type of pharmacy care – moving it from a transactional practice to a care-focused, concierge service that provides a highly personalized experience for the patients who need the most support.”

Acquired by IngeionRx (now CarelonRx) in 2020, ZipDrug applies artificial intelligence and human connection to understand an individual's needs and remove barriers to care – such as transportation, cost issues, or the complexity of a medication regimen. And it connects consumers to local, high-performing pharmacies that have a proven track record of higher medication adherence rates and quality care at lower costs. ZipDrug’s platform, which integrates software in the pharmacy, allows us to have more control over the experience and enables us to transition from a transactional to a care-focused concierge service.

ZipDrug reports positive results and savings for its consumers, including an approximately 7% increase in patients’ medication adherence – which is significant when average national adherence rates to chronic medications is only about 50%. And ZipDrug’s net promoter score, a measure of customer satisfaction, is 80 compared to an average score of 20 for retail pharmacies.

ZipDrug transformed the pharmacy experience for Ron and Betsy, Medicare Advantage members from Ohio. Ron used to take 14 pills each day, many two or three at a time, to deal with complex health issues. With so many medications to sort out, the couple worried they would miss a dose or mix up pills.

Drawing on claims data, ZipDrug had identified Ron as an ideal candidate for the program and connected Ron and Betsy with an independent pharmacy that would package Ron’s medications into pill packs and synchronize his refills to fall on the same day. An added bonus: the pharmacy, which delivers, is located less than half a mile from their home.

“Taking medications became so much easier and less stressful for Ron thanks to ZipDrug and our local pharmacists,” Betsy said.

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