Around here, there’s no such thing as a minor member success story. We celebrate them every day, no matter how much we’ve helped a member save. Some stories, however, transcend dollars and cents. One of those emerged this week.
Background:
- Middle-aged male member on a high-deductible health plan
- Pharmacy claims suggest diabetes, high blood pressure, heartburn, constipation, irritable bowel syndrome and glaucoma
- Despite a substantial prescription fill every month, this member was able to pay his out-of-pocket share—until he couldn’t anymore
Even with a solid employer-sponsored health insurance plan, this member—let’s call him “Barry”—had to skip what may be the most important drug in his medicine cabinet: eye drops to treat the glaucoma.
Anyone familiar with his type of glaucoma knows if you go without the eye drops for long, your eyesight will go away for good. The more expensive of Barry’s two eye solutions is $661.89 per fill; the other is $174.
A Tough Year Gets Easier
Two significant events happened in Barry’s world on January 1. His high deductible reset to zero, and his spouse’s employer introduced Rx Savings Solutions to employees and their families.
Paying entirely out of pocket while in the deductible phase, Barry regularly filled his many prescriptions—except the critical $661 eye drops, even with copay assistance available from the manufacturer.
Members for whom we have digital contact information receive regular Savings Notifications from Rx Savings Solutions via email or text. These messages alert members to slam-dunk savings opportunities. One problem: We didn’t have Barry’s email address or phone. But we did have his physical address.
We targeted members like Barry with direct-mail Savings Notifications in March. He reached out to us shortly after the letter arrived. He explained to our Pharmacy Support team that he’d stopped filling Travatan Z¨ because he could no longer afford it—even knowing the consequences.
After a quick phone call to his ophthalmologist to request changing Barry’s prescription to a therapeutic alternative (latanaprost, generic Xalatan¨), we were able to lower his bill to $32 per fill
We did the same for his other eye drops, moving from an expensive combo of two active ingredients to the same ingredients taken individually, a savings of more than $150 per fill. That’s over $5,000 saved per year, if you’re keeping score. Same effective treatments, same pharmacy. Just a couple more squeezes of the dropper each day.
The Bottom Line (and Beyond)
We don’t know anything about Barry beyond his pharmacy claims and what we can extrapolate from them. He presumably had the means to afford all his medications prior to this year. Maybe he and his family were hit with some other financial hardship. All we know for sure is that left untreated, glaucoma leads to blindness.
Who’s looking out for patients like Barry? Rx Savings Solutions analyzes claims like his 24/7/365. Any time a savings opportunity is found, we make sure to reach him by whatever means possible. Because there’s one thing we’ll never lose sight of: You never know when someone can save a lot more than money.
