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

MRIoA’s MyCareChoices™–Rx allows health plans and Pharmacy Benefit Managers (PBMs) to leverage national experts to ensure use of evidence-based guidelines for high-cost drugs in treating complex medical conditions.

MYCARECHOICES™-RX DIFFERENT FROM OTHER INDEPENDENT REVIEWS?

Scale and Experience

Proven record in medical review with access to 700+ physician reviewers covering 150+ specialties

Speed to treatment

Timely, expedited reviews with expert determinations allow for optimal patient outcomes and member satisfaction

Return on Investment

Actively manage drug spend

30 million Americans are living with one rare disease
Ensure members have access to the right medications at the right time for the right diagnosis

$12.6M cost avoided

Plan/PBM not paying for an ultra-high-cost medication not indicated based on the patient’s condition

Patient Scenarios

Scenario #1: Zolgensma, findings indicate appropriate use and savings if reviewed by MCC – Rx National Expert

  • Patient Diagnosis: extremely complicated disease involving complex genetic testing requirements
  • Cost: $2,100,000
  • 20 cases evaluated
    • 14 approved – 6 denied
  • Reasons for denial:
    • The use of Zolgensma in patients with advanced SMA (e.g., complete paralysis of limbs, permanent ventilator-dependence) has not been evaluated
    • Perform baseline anti-AAV9 antibody testing prior to Zolgensma infusion
    • Evaluate for severe or symptomatic liver disease, thrombocytopenia, elevated troponin or any other serious underlying medical conditions that may heighten the risk of Zolgensma therapy
  • Alternative recommendation to patient
    • MCC- Rx does not provide an alternative (unlike standard MCC – Your 2nd Opinion)