As a trusted advisor to our clients, Pharmacy Benefit Dimensions (PBD) provides personalized attention and guidance for our members to ensure they receive continuous access to high-quality, low-cost care.
Superior servicing and diligent plan guardianship compliment the comprehensive clinical programs and cost mitigation strategies we are employ to effectively manage prescription drug costs.
Problem
Due to a national generic drug backorder of attention deficit hyperactivity disorder (ADHD) medication, members were required to fill branded drugs to avoid any therapy disruption. This switch from generic to brand increased costs for both the plan and the members, prompting the plan sponsor of a school district to reach out to our Client Support Team on behalf of our member. This member was nearing the end of their supply, and the increased copay cost for the branded drug posed a financial burden and the risk of disruption to their therapy.
To ensure continuation of therapy and mitigate the financial impact of the copay increase, PBD stepped in to explore options for intervention that did not force the member to go on an alternative medication.
Medication Details: Focalin XR is a brand-name ADHD medication. While a generic version is available, it was placed on national backorder, making the generic option temporarily inaccessible.
Client Overview
Industry: Education
Group Size: 650
Plan Type: Self-Funded
Solution
PBD’s team took prompt action to address the immediate and future needs of the member:
- To maintain access to therapy, PBD placed an override that allowed the member to fill the prescription for Focalin XR to eliminate any delay in treatment.
- A second override was placed to cover the cost difference between Focalin XR and the generic medication, effectively insulating the member from the price surge.
Proactive Measures: PBD’s expert team then placed an additional Prior Authorization to allow members continued access to Focalin XR at the appropriate cost for the duration of the shortage. Once proper access to the generic is restored, members will then seamlessly step back into their originally prescribed regimen.
Results
When time was of the essence, PBD’s dedicated Client Support Team found a solution efficiently and effectively. Through our collaborative effort, our member was safeguarded from the burdensome price increase while maintaining access to their necessary medication.
Supply chain disruptions may be out of our control, but with PBD’s emphasis on prompt intervention and proactive measures, clients and members can rest assured that our team is continuously working to provide high-quality care with considerations for both price and availability.