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Wellfleet Rx savings by the numbers: A 2021-2022 analysis

Wellfleet’s student focus

At Wellfleet, we strive to meet the ever-changing needs of our student members. A core tenant that acts as our North Star is the Triple Aim – providing the right care at the right price to the members’ satisfaction.

As a result, we are constantly identifying methods to increase access to clinically acceptable treatments while also lowering costs for our plans and student members. Continuous analysis of the safety, effectiveness, and cost of the drugs covered by our Wellfleet Rx Student Formulary is part of that approach.

We reviewed the impacts of Wellfleet’s student-focused pharmacy solution over the course of the 2021-2022 school year. Here’s what we found.

Wellfleet Rx formulary $0 copay and preferred alternative savings

One of the key features of the Wellfleet Rx Student formulary is that there are more than 40 medications available with no copay. This is in addition to the $0 copay drugs mandated by PPACA, like contraceptives and vaccinations.1 The additional medications range from antibiotics, behavioral health medications, and dermatology products, to continuous glucose monitors for diabetes and naloxone for opioid overdoses.

In addition, we have efforts in place to help guide members toward lower-cost and preferred alternatives through the formulary design. An example of this is our formulary tiering which sets some high-cost generics at a higher copay tier to help incentivize the use of lower cost generics, which are placed at a lower copay tier. This encourages lower copays for the student member and lower expense to the school plan. 

When we look at the avoided drug costs for our participating school partners over the 2021-2022 plan year, $2.5M could be attributed to the utilization of formulary preferred options over their higher-cost alternatives.2

Wellfleet has observed great outcomes with respect to the adoption of $0 copay drugs. In 2021, we provided coverage for 22,000 $0 copay drugs. The drugs included in the formulary could have helped students avoid $330,000 in copays2 and $1.4 million in avoided prescription drug cost for their school plans!2

Wellfleet Rx claims-based savings

To help incentivize the use of lower cost alternatives beyond the formulary design, we also have point-of-sale (POS) messaging that goes to participating pharmacies. The POS messaging lets the pharmacist know in real-time if they’re processing a claim with a lower cost alternative, so they consider speaking to the prescriber about making a change.

We also send monthly letters to members and their prescribers when these opportunities exist. When looking at the success of our mailing campaign, there was a conversion rate of 11 percent.2 Further, as a result of the converted prescriptions, school plans were able to save $108,000!3

Utilization management savings 2021-2022

In the same spirit of our other programs, we have utilization management programs in place, to help ensure student members are receiving the most appropriate medications, while helping to lower the overall cost of health care. The utilization management strategies we have in place include step therapy, quantity limits, and prior authorizations.

  • Step therapy – A practice that starts members with preferred medications for their treatment (a ‘step’ drug) before non-preferred medications are covered.
  • 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 clinical criteria need to be met and prescribers may be required to submit documentation prior to obtaining the medication.

We use clinical and pharmacoeconomic data to make sound utilization management decisions. The data helps us identify what medications should require prior authorization, step therapy or quantity limits.

Further, we utilize the expertise of a team of healthcare providers from a wide variety of specialties and care settings to help us develop clinically appropriate utilization management techniques.

When reviewing the 2021 outcomes of our utilization management programs, we observed 13 percent combined savings related to those edits, which is close to $5 per member per month (PMPM) in savings!3

Discover Wellfleet Rx

Wellfleet Rx is a solution that accompanies plans from Wellfleet Student, and offers student-focused features, tools, and resources. We approach our programs with the goal of meeting students’ physical, mental, and financial needs, while simplifying their lives. Get to know how Wellfleet Rx compares to commercial prescription plans.  

If you’d like to learn more about Wellfleet’s Student Health Insurance products, services, and offerings directly from the Wellfleet Student Health team, check out our on-demand webinar.

Resources:

1 Cigna (n.d.). PPACA No cost-share ($0) preventative medications. Retrieved December 6, 2022, from https://www.cigna.com/static/www-cigna-com/docs/hcr-prev-coverage-zero-dollar-ppaca-preventive.pdf.

2 Wellfleet (2022, August). Preferred alternatives savings. Retrieved November 8, 2022. Unpublished company document.

3Wellfleet (2022, September). Student focus and features. Wellfleet Rx by the numbers. Retrieved December 6, 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.