December 7, 2015

Case Studies: GTRx Specialty Pharmacy

Discount more than doubled on Yervoy cancer case
Self-Funded Employer Group had expensive cancer case (Yervoy) with only a 20% discount.  GTSN worked with the provider to increase the discount to 50% and only charged a fee on the additional savings.  Client saved another $100,000 plus monthly.

Doubled client discount on Tysabri MS drug
A Stop Loss client asked us to talk with one of their TPA’s regarding an ongoing MS case using the drug Tysabri.  The provider had rolled out a very large charge increase the prior year, more than eating up their current discount.  Worked with large provider to double the discount from 20% to 40% helping roll back most of the price increase the group had been hit with going forward.  Saving the client another $60,000+ per year and GTSN only charged a fee on the additional savings.

100% savings to Client
A client approached GTSN with a Specialty Drug case that was going to be very expensive per year.  After review by our staff Nurse and Pharmacist GTSN determined there was a manufacturer financial assistance program that had not been explored by anyone for this patient.  After gathering the information and talking with the program GTSN was able to help the client obtain 100% coverage for the drug.

Infiliximab case increased client savings $5,000 per treatment
Client referred drug case with decent initial discount. GTSN worked with the provider to increase savings over $5,000 per treatment over prior discount.

Soliris Orphan Drug – $435,000+ Savings
A self-funded employer group had a member with a rare condition needing the drug Solaris every other week for life.  Facing charges in excess of $1.4 million per year for this one medication the group needed help.  GTSN worked with the provider, group, TPA and stop loss carrier to negotiate a 31% discount for this one drug with provider sign off.  Projected annual savings on this single drug is over $435,000 per year.

Doubled savings on Soliris drug case with City health plan
MGU referred case for one of their self-funded employer group health plans struggling with the rare drug case Soliris. GTSN worked with the provider to lower the reimbursement which more than doubled the plan’s savings over their primary PPO to $18,000+ per treatment.


Looking for ways to get your Specialty Rx costs at a more manageable level for your plan?  Contact GTRx today to discuss your needs.

Hy F. Byrd, Specialty Rx Lead
Vice President – Business Development
615.712.6289 direct