We keep a pulse on the pipeline and know the trends; that’s why we’re uniquely qualified to deliver targeted solutions for high-cost disease management.
What are our condition-specific programs?
Our comprehensive oncology solution combines cost-of-care strategies (including leading-edge medical pharmacy programs) with a holistic patient care management program to offer integrated, flexible interventions that address the many complexities of cancer care while driving more value through improved quality of care and quality of life for the members we serve.
Our multi-faceted approach to hemophilia management aims to increase quality of care for patients through appropriate use and personalization of therapy, as well as reduce overall costs through utilization management, dose optimization, standardizing specialty pharmacy dispensing, and making impactful interventions with key opinion leaders from our Expert Clinical Network (in fact, we engage this network of nationally-recognized and world-renowned experts across all condition-specific programs and other solutions). —want to learn more?).
We are able to add more value and ensure patients with autoimmune conditions—like rheumatoid arthritis, psoriasis, Crohn’s disease/ulcerative colitis—receive appropriate treatment through the power of integration with solutions that include prior authorization, post-service claim edits, site of service management, network reimbursement, medical formulary optimization, and a biosimilar strategy.
Our goal is to reduce inappropriate utilization and provide clinically effective care through dose optimization, proper vial management, and partner with providers with education outreach to ensure appropriate care.
In Medicare, ophthalmic anti-VEGF injections are second behind the oncology category in per-member-per-month cost for medical benefit drug spend—that’s why we have a solution that partners with providers to help mitigate rising costs.
We are seeing growing approvals in niche treatments for ultra-rare conditions as well as gene therapy and precision oncology medications—our next-level solutions for rare disease management includes components of enhanced prior authorization, site of service program expansion, and digitally-supported case management services.