Taking the Extra Step to Save You Money



A Special Phone Call Helps Members Lower Rx Expenses

The next time you reach for your medication, take a moment to think about all of the behind-the-scenes work required to get that pill in the palm of your hands. From the volumes of research and raw ingredients, to all of the roads traveled in between – there’s a lot that happens to protect your health.

In addition to all that occurs with the pill itself, there’s a host of activities that happen behind-the-scenes in the District dedicated to ensuring the end cost of the pill doesn’t drain the dollars in your wallet. Each month, the Pharmacy Benefit Management (PBM) subcommittee of the District’s Joint Health Management Board (JHMB) meets to assess overall Rx program management, as well as member experience optimization, clinical program efficacy, and vendor process improvement.

While the subcommittee does not have access to individual member data in regards to prescriptions and usage, through routine program management analyses, the group noticed a drop off in usage of a particular maintenance medication. This reduction in medication usage could prove harmful for the long-term health of members, if not monitored properly. As a result, the subcommittee recently requested Elixir (formerly EnvisionRx) to conduct outreach to this key group of members, whose usage may have been affected by a prior prescription benefit change.

It Only Takes a Phone Call to Make a Difference

In the fall, Elixir conducted the outreach campaign using both letters mailed to members’ home and follow-up telephone calls. Of the members that were contacted, representatives from Elixir were able to better understand the individual reasons for members’ change in medication activity. In a few cases, Elixir was even able to assist members in completing the necessary processes (and documentation) to receive special prescription assistance to continue to receive the maintenance medication and ultimately reduce their out-of-pocket expenses in the long run.

Our Mission – Informed and Responsible Health Care Consumers

Given the recent positive outcomes from this outreach effort, the JHMB is considering similar practices in the future to help members better understand the plan and take full advantage of the benefits available to them and their families. These efforts are part of the JHMB’s continual efforts to promote informed and proactive decisions regarding health benefits in the most cost-effective, innovative and efficient manner, and ensure members become informed and responsible health care consumers.

So the next time you receive a call from a benefits vendor on behalf of the JHMB, you might want to answer the call (or call back). It just might save you money and help improve your health outcomes.

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