Over a two year period, Araya reduced client cost 14% using step therapy edits. The edits targeted 28 therapeutic categories accounting 30% of plan spend. Savings were calculated by evaluating the cost per day of therapy by class for the three month period prior to initiating the edits, to the cost per day for same three month period one year later.
Step therapy edits are designed to improve compliance with therapy protocols developed from peer reviewed literature and expert panel guidelines. Araya’s clinical team reviews plan utilization to identify specific conditions that drive plan costs. Based on client specific utilization trends, Araya chooses which edits to activate. Araya’s selective approach to deploying step therapy edits maximizes savings while minimizing member disruption.
Araya’s program is also sensitive to established therapies. If a patient has used a second line therapy in the past six months, they are allowed to continue. This practice has greatly increased program acceptance with less than 1% of rejected claims being overridden at the prescriber’s request.
Araya offers our step therapy program at no additional charge to our clients. It is included in our base administrative fee. We believe that administering a pharmacy program is more than simply processing claims. Clients should not incur additional charges for cost effective, clinically appropriate care.
