ELMCRx Solutions
ELMCRx Solutions offers a suite of clinically based solutions designed to improve PBM contract performance. Our team of Clinical Pharmacists focus on delivering effective solutions to improve cost, quality and utilization.
Our years of working inside the PBM has helped us understand where contracts underperform. Correcting this underperformance is what our programs are designed to solve for. We have served thousands of members and performed more than 25,000 reviews since 2019.
The ELMCRx Specialty and High-Cost Rx Program is designed to help manage the rising cost of Specialty medications that require a Prior Authorization or exceed a certain cost threshold. We:
- Enforce Step Therapy
- Manage dose and quantity limits
- Require documentation including chart notes and lab tests for approvals
- Help plans save through biosimilar management of high-cost medications
This program produces significant plan savings with minimal member disruption.
New treatments to help treat diabetes and obesity are exploding in popularity and cost. GLP-1 claims have surged, consuming up to 30% of total prescription drug spending for some plans. ELMCRx’s GLP-1 Management Program has significantly reduced plan costs while ensuring that medication users have access to their medications. Our clients see savings of between 25% and 35% in GLP-1 spend under our program.
How does the program work?
- Enforce step therapy – we ensure that first line medications have been tried and have failed
- Two Annual Medication Reviews – we monitor treatment effectiveness of treatment twice each year to ensure therapy aligns with patient needs and plan guidelines
- Denial of Cosmetic Prescriptions – we approve medications for diabetes and weight loss management using clinical records and bloodwork to prevent abuse
- Proven Cost Reductions – our methods along combined with an appropriate weight loss program have helped reduce costs by up to 30%, providing substantial savings without compromising care.
For information on how we can help your fund save on high-cost specialty medications and GLP-1s, please contact:
Mary Ann Carlisle mcarlisle@elmcgrp.com 484.433.1412 www.elmcgrp.com
