Independent Review of High-Cost Specialty Drugs to Ensure Evidence-Based Care and Appropriate Utilization of Treatments

MRIoA’s High-Cost Specialty Drug Review Solution allows health plans, Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) to leverage our panel of specialists to ensure use of evidence-based guidelines for high-cost drugs in treating complex medical conditions.

MRIoA’s  High-Cost Specialty Drug Review Solution targets medications with a monthly cost between $5K-$200K for a specialist panel review to ensure use of evidence-based guidelines to either influence the prescriber acceptance of therapeutic  recommendations or help change the prescribing habits for high-cost drugs in treating medical conditions where lower cost drug alternatives are available.  These reviews help health plans, TPAs and PBMs to implement cost-saving solutions while…ensuring members have access to the right medications at the right time at the right costs..

Case Study – Hereditary Angioedema (HAE)

HAE Background

  • HAE is an extremely rare and potentially life-threatening genetic condition
  • Patients often use a combination of on-demand treatment and long-term preventive treatment

Driving Cost Savings with Therapeutic Interchange

  • Dramatic cost difference between treatment options
  • Significant cost savings possible if prescribers accept therapeutic interchange recommendations

Savings Example

  • Haegarda’s six month mean cost was 22% lower than the therapeutic equivalent Takhzyro
  • Plans able to save $52,000 annually per patient when prescribers opt for therapeutic interchange