A Seamless Specialty Drug “Carve-out” Plan

  • Covers both pharmacy and medical benefit drugs
  • VIVIO qClinicals™ – model-based care management
    • Real world effectiveness primary driver
    • No arbitrary formularies
    • PA replaced with individualized care planning
  • Transparent procurement model, lowest cost acquisition
  • Simple & transparent fee

Comprehensive care

Erase the arbitrary dividing line between pharmacy and medical benefits.

Targeted care

Fewer than 2% of your members drive 50% your drug spend.

A targeted solution works best. No member disruption, easy implementation, rollout program anytime of year, no complexity for you.

Simple care

We take care of the details, so the member doesn’t have to.

High cost specialty conditions

Managed one person at a time.

Rheumatoid Arthritis

  • Affects 1.5M Americans
  • 3X more common for women
  • Staying active can help reduce pain and protect joint health

Psoriasis

  • Affects 7.5M Americans
  • Most likely appears between ages 15-35
  • Up to 30% will develop psoriatic arthritis

Crohn’s Disease

  • A type of inflammatory bowel disease affecting 750K Americans
  • Children are twice as likely to be diagnosed
  • 2X risk for smokers

Cancer

  • 1.7M newly diagnosed Americans in 2019
  • 600K deaths in 2019
  • The cancer death rate has fallen 27% since the peak in 1991

HIV

  • Affects 1.1M Americans
  • 14% are unaware of their condition
  • Without treatment, HIV usually progresses to AIDS in 10 years, or sooner in some people

Multiple Sclerosis

  • Affects 1M Americans
  • Rate in northern states is 2X that of southern states below 37○ Parallel
  • Antiviral treatment cures > 90% of people treated

Hepatitis C

  • Affects 3.5M Americans
  • 15-45% get better without receiving treatment
  • Antiviral treatment cures > 90% of people treated

Severe Asthma/CIU

  • Affects 8% of Americans
  • Prevalence in children, is higher than adults
  • Causes 1.3M ER visits, 450K hospitalizations and 3,500 deaths/year

Cystic Fibrosis

  • Affects 30K Americans
  • More than 75% are diagnosed by age 2
  • More than half of CF population is age 18 or older

Hemophilia

  • Affects 20K Americans
  • Median diagnosis age is between 1 and 36 months depending on severity
  • 1/3 of people have no known family history

Enzyme Replacement

  • 8K people with Fabry disease
  • 6K people with Gaucher disease
  • Other conditions include Wolman disease, MPS and Pompe disease

Growth Hormone Deficiency (HGH)

  • 50K people with Growth Hormone deficiency
  • Can be congenital or acquired in childhood or adult life
  • Side effects in children include sparse hair growth and frontal recession

Experimental drug identification

We identify experimental drugs and therapies so you don’t have to pay for therapies that should be considered experimental.

Over the past 30 years new types of drug approvals require declining standards of evidence.

Physician profiles

We use ProPublica and Open Payments to profile physicians who prescribes specialty therapies for your members.

We confirm the doctor is prescribing for the right reason, not self-interest.

Technology drives lower costs and better outcomes

Our self-improving clinical models use algorithms and machine learning.

We’re transparent

You own your own data and you’re free to examine any underlying contact at anytime. Our only revenue source is our PMPM fees, and that’s it.

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