See also: Ohio measure takes aim at Rx costs. The criteria used to determine what is on formulary often assume a "one-size fits all" approach to medication management. Preferred treatments are selected based upon what works for the "average" patient, regardless of disease severity, age, gender, race or patient preferences.
That was an issue that the city of Fort Collins had not yet grappled with by 2016, though it had the flexibility, with a self-funded program, to go either way. By choosing "unbundled" for its pharmacy benefits, the city saved a bundle-more than $1.
"Bundled payment and other programs are going to change how we have to manage drugs across a health system," says Edward Choy, PharmD, president of Health Systems Operations for CPS. "Inpatient drugs used to be under formulary, while outpatient drugs were managed by private insurers and pharmacy benefit managers.
Fort Collins is the largest city in northern Colorado and home to 150,000 within the city boundaries and another 300,000 in the surrounding region. Its employee benefits program has 1,900 benefit-eligible and 4,000 total plan members, including those covered through intergovernmental agreements.
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Specialty Pharmacy: Lowering Total Healthcare Costs . Average savings (10,000 life group). Typical savings for combined $343,000 medical and pharmacy costs across 12 specialty conditions. 1. Specialty program outcomes based on UHC commercial membership 2007 to 2010. Network contract savings based on 2011 commercial FI membership.