A self-funded public school district was noticing an uptick in their annual spend on prescription drugs, specifically specialty drugs. With specialty drugs being notoriously expensive due to their technical administration, unique storage requirements, and overall lack of availability, the group reached out to BMI for a solution to reduce their costs.

Overnight, the Missouri Public School District found themselves covering one specialty drug per 50 participants. To put this in perspective, the average cost for a single specialty drug is close to $85,000 per year. This reality resulted in the group’s specialty drug RX spend becoming more than 30% of the plan’s annual claim cost.

BMI stood by their client and accepted the challenge. While the BMI team could not control the rising cost of prescription drugs, they could leverage their long-term relationships with their RX management partners. After speaking with several of their partners, BMI was able to place each of the plan members in assistance programs where the member paid nothing for their medication. In addition, the total annual RX costs for the group were reduced by 25% of their total claims expenses.

The reality is the cost of prescription drugs, especially specialty drugs, will continue to rise over time. As groups start to feel the pain of these increased costs, so will their employees. Great TPAs solution with their groups to find the best care for their members at the right cost. Thanks to BMI and their long-term partner relationships, the Missouri School District was able to significantly reduce the cost of care for their members without sacrificing the quality of care.