Specialty Pharmacy

Back in 2016, benefits staff at CHG Healthcare found a charge for $174K in the monthly claims spend report. It wasn't a mistake; it was the actual price for a specialty drug being used to treat a rare medical condition. Forecasting further exorbitant costs without evidence of effectiveness, CHG Healthcare partnered  with VIVIO Health Inc in 2017 to implement a specialty drug carve-out plan that covers both pharmacy and medical benefit drugs. Between 2017 and 2020, the program netted this progressive purchaser $4.4M in savings with their plan participants paying $0 for their speciality medications.