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
Erase the arbitrary dividing line between pharmacy and medical benefits.
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.
We take care of the details, so the member doesn’t have to.
High cost specialty conditions
Managed one person at a time.
- Affects 1.5M Americans
- 3X more common for women
- Staying active can help reduce pain and protect joint health
- Affects 7.5M Americans
- Most likely appears between ages 15-35
- Up to 30% will develop psoriatic arthritis
- A type of inflammatory bowel disease affecting 750K Americans
- Children are twice as likely to be diagnosed
- 2X risk for smokers
- 1.7M newly diagnosed Americans in 2019
- 600K deaths in 2019
- The cancer death rate has fallen 27% since the peak in 1991
- 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
- Affects 1M Americans
- Rate in northern states is 2X that of southern states below 37○ Parallel
- 2-3X more common for women
- Affects 3.5M Americans
- 15-45% get better without receiving treatment
- Antiviral treatment cures > 90% of people treated
- Affects 8% of Americans
- Prevalence in children, is higher than adults
- Causes 1.3M ER visits, 450K hospitalizations and 3,500 deaths/year
- Affects 30K Americans
- More than 75% are diagnosed by age 2
- More than half of CF population is age 18 or older
- Affects 20K Americans
- Median diagnosis age is between 1 and 36 months depending on severity
- 1/3 of people have no known family history
- 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.
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.
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.