Wellfleet Rx: Going skin-deep uncovers substantial savings

Did you know that nearly 95 percent of adolescents (12-25 years) have acne, a chronic inflammatory skin condition that typically affects the face, chest, and back? According to several research studies, adolescent acne affects 81 to 95 percent of young men and 79 to 82 percent of young women.1

Knowing how highly-utilized and important acne and dermatology medications are to our student members, the Wellfleet Clinical team developed programs to aid in alternative medication education and cost savings. Here is a deeper look at why, and the outcomes of those efforts.

Wellfleet Clinical team constantly evaluates Rx program

The Wellfleet Clinical team is constantly evaluating the pharmaceutical landscape for the benefit of our clients and student members. This includes monthly drug utilization analysis and a bi-annual review of the Wellfleet Rx Student Formulary to ensure the most cost-effective, clinically-proven medications are prioritized.

The monthly review results in proactive communications to students to help ensure they and their prescribers are aware of quality, potentially lower-cost options. Annually, measures are taken to update plan details or design for the benefit of the plan and student members.

Continual review of utilization and the latest clinical information is so important, as it helps ensure we are providing cost-effective access to highly utilized drugs and that proper utilization management techniques are in place. In fact, because of this review process, we now offer nine topical dermatology and acne products under our Wellfleet Rx $0 drug list to ensure the accessibility of these products for our student members.

Identifying opportunities for lower cost alternatives

The Clinical team recently reviewed the outcomes resulting from their 2020-2021 plan year efforts to educate members and prescribers utilizing acne and dermatology medications, as this class of medications account for a high percentage of overall plan spend.

In total, these efforts resulted in a three percent conversion rate among the student members who received communications. Collectively, student members saved $5,000 in out-of-pocket expenses, while their school plans saved $19,488 for the 2020-2021 plan year.1

Cost savings from Wellfleet Rx utilization management strategies

In addition to aiding students with education on savings opportunities, Wellfleet Rx plans leverage utilization management strategies to help ensure student members are receiving the most appropriate medications, while lowering the overall cost of health care.

The utilization management strategies used include step therapy, quantity limits, and prior authorizations.

  • Step therapy – A practice that starts members with preferred medications for their treatment before non-preferred medications are covered. Preferred medications are clinically safe, and they help lower member and plan costs.
  • Quantity limits – A structure that puts a limit on the quantity dispensed, to help ensure safe and appropriate dosing.
  • Prior authorizations – A pre-approval process where criteria need to be met prior to obtaining the medication and can include documentation provided by the prescriber. This helps promote safe and effective medication use.

When evaluating the outcomes tied to acne & dermatology utilization management during the 2020-2021 school year, it was found that 69 percent of students received the original product prescribed, while 31 percent converted to a lower-cost prescription or OTC alternative, helping their school plans save a total of $111,615!1

Cost savings when appropriate

For the 2020-2021 school year, school plans saved more than $131,000 from students who converted because of the mailing program and utilization management edits for acne and dermatology medications.1

It is important to note, while alternative medications exist, not all have the same indications, which means that an alternative may not always be appropriate for the students’ condition. Wellfleet may not capture all the students’ medical history from previous carriers, so in some cases, alternatives may have already been trialed and deemed ineffective for their needs.

It is ultimately the provider making the decision on a clinically appropriate option for their patient, so if a patient does not mention alternatives or if the provider does not think it is appropriate to switch back to a previously trialed medication, they are free to maintain their current prescription.

Wellfleet Rx provides winning strategies

Providing quality service to our clients and members is paramount to what we do every day. That is why we are always reviewing our programs to identify ways to improve our student members’ experience, while helping save them and their schools money. It is a key tenet of meeting the Triple Aim – providing the right care, at the right price to the members satisfaction.

Find out how Wellfleet Rx’s utilization management strategies helped plans save more than $4,000,000 in 2021!


1 Wellfleet (2022). Outcomes from management of acne/dermatology medications under Wellfleet Rx student formulary. Retrieved October10, 2022. Unpublished company document.

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Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies.