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How Putting Patient Safety First Led to a Better Outcome for Everyone
When it comes to patient safety, there’s no room for compromise. Ensuring members receive the right medication at the right time in the right setting isn’t just about cost but care. But what happens when barriers stand in the way of access?
At Serve You Rx, we’re committed to saying yes to solutions prioritizing patient well-being while helping health plans manage costs. In a recent case, we worked closely with a plan representative, a member’s family, and a healthcare provider to ensure a 16-year-old patient received a critical off-label medication — without breaking the bank.
Advocating for the Patient’s Safety
This case involved a minor who needed a specialty infusion medication to prevent vision loss and blindness due to uveitis. The process was anything but simple.
- Unresponsive Caregiver: Since the member was a minor, communication was required to go through her mother, who wasn’t returning calls. Instead of letting the process stall, we partnered with the highly engaged plan representative, who took extra steps to connect with her directly.
- Financial Barriers: The mother explained that financial assistance paperwork had been misplaced at the manufacturer’s Patient Assistance Program (PAP). We continued to follow up and ensure the process moved forward.
- Physician Roadblocks: The prescribing physician refused to switch to a biosimilar despite formulary limitations, leading to challenges in sourcing the medication affordably.
Finding a Safer, Cost-Effective Solution
We knew we had to find a solution that maintained continuity of care and patient safety while minimizing financial strain.
Securing an Affordable Administration Site
The original treatment plan sourced the medication through the Medical Plan at over $20,000 per dose—excluding additional clinic fees. Due to white- and brown-bagging restrictions, finding an alternative location was key.
We identified a new clinic that partnered with a local pharmacy to source the medication at just $5,000 per dose — a fraction of the cost.
Prioritizing Clinical Expertise for Safe Administration
This patient had a history of challenges with line placement, making specialized care critical. We worked with the plan representative to secure a clinic with:
- A lead nurse trained in line placement techniques
- The right equipment to ensure safe infusions
- A location closer to the patient’s home for convenience
- Private infusion rooms, providing a comfortable and supportive setting for both the patient and their family
Ongoing Support for Financial Assistance
Beyond securing access, we continue to monitor the PAP application process, which, if successful, could save the plan an additional $5,000 per month on medication costs. The member has now been approved for PAP for all of 2025, ensuring continued access to the medication while saving the plan this recurring expense.
Results: Patient Safety and Savings
Thanks to a proactive, patient-first approach, this solution delivered:
- Seamless access to life-saving medication
- A familiar and supportive clinical team for safe administration
- A 75% cost reduction—from over $240,000 annually to $60,000
- Peace of mind for the family and plan sponsor
At Serve You Rx, we create solutions and not just process benefits. Your members’ safety is our top priority, and we’re committed to making pharmacy benefits work for you.
Need a partner who prioritizes patient safety while reducing costs? Let’s talk.
About Serve You Rx®
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what's best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say "yes" to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
