© 2020 by Orchestra Rx LLC

  • Paul Ford - CEO

Specialty Drugs, Coronavirus, & the Opportunity to Reduce Cost

The promise of a miracle drug to combat Corvid-19 like Hydroxychloroquine has created polarizing perspectives on the optimism of prescription innovation and flat-out cynicism as reported by Bloomberg. The reality of prescription drug alternatives that are available to reduce overall health care cost is very real and will be inserted into mainstream relevance.

Several years ago a Union group in California, like many other unions and employers, were facing double-digit cost increases to their health plan. Working with multiple consultants and committees, they were searching for an opportunity that could act as their proverbial "silver bullet". They were challenged with several dynamics that many employers face contractually or via managed perceptions when providing benefits to the employees and their families which are the life-blood to all companies in operation.



Dynamic #1: The perceived or actual reduction in a benefit coverage.


Whether your company is a high-flying tech company with novel perks like bringing your dog to work, on-site chefs, unlimited PTO, gold standard benefits or you are a school district and wages are low, Cost-of-living- COLA increases are lower or paused, implementing traditional cost-cutting measures such as drug exclusions, deductibles, higher co-pays and coinsurance are perceived as benefit coverage reductions and restrictions. It is very hard culturally to remove benefits or coverage levels from employees that are used to a certain benefit level. Employers struggle to find ways to save without upsetting the membership base.



Dynamic #2: Rising cost, limited options


Kaiser Family Foundation (KFF) has measured the cost increase of healthcare compared to wage increases over the last 10 years. When employers don't pay their employees more relative to the cost shift of increase deductibles and and premium cost, there is no end in sight for a remedy or balancing of these dynamics. With the reluctance of employers to match the pace of rising healthcare cost, the only real viable option is to reduce healthcare cost with this framing in mind.



Dynamic #3: Challenges capturing ROI from programs and efforts to reduce cost


CEOs, COOs, CFOs, VP of Human Resources, Benefit Managers have been bombarded by their consultants and innovative solutions companies with new apps, services, programs that address a range of topics including wellness, diabetes, nutrition, sleep, mindfulness, clinic-based care, supplemental discount programs, and telemedicine. When these solutions are pressed for metrics and Return-On-Investment (ROI) analytics most cannot. This "solution-fatigue" This is typically due to siloed data, inability to target and measure versus a control group, or the benefits of the program are not realized potentially for several years once a point of maturation is reached. These business leaders need data and analytics on programs with hard metrics, numbers and attribution to membership impacts.



Opportunity: Implementing FDA-approved drug alternatives via programs and formulary designs that reduce pharmacy benefit cost up to 32.7%


The convergence of the dynamics shared in this article has created a shift in mindset and readiness to implement smart solutions that can reduce pharmacy cost. By leveraging FDA-approved alternatives and creating employer sponsored programs that introduce access to these alternatives beyond a "brand-to-generic" substitution. These programs can foster member experiences that lead to better health outcomes and lower cost while expanding drug options. Programmatic consumer-patient messaging and access to tools to simplify the process of being an accountable, well-equipped healthcare consumer with the ability to navigate towards better health without compromising health, quality or cost.


The science behind therapeutic alternatives and efficacy has existed for decades. Having a situation like Corvid-19 that prompts more stakeholders to look at alternatives and introduce programs into health plans that creates better health with lower cost. If you would like to learn more about these challenges and opportunities to save contact us and hello.


Be well. Be safe. Be smart.