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How Emry Saved a Member $14,760/yr by Navigating Rx Prior Authorization

Emry assisted a member in securing full insurance coverage for their medication, reducing out-of-pocket costs to $0.

Situation

A member required medication for managing their Type 2 Diabetes Mellitus, and their physician prescribed Saxenda. Saxenda was not covered by the insurance plan due to its classification as a weight loss drug, resulting in a high monthly cost of $1,230, which the member could not afford. Navigating the complexities of insurance coverage for medications can be challenging for members. Our medication guidance services are designed to assist members in understanding their medication options and insurance benefits.

Service Provided

Saxenda contains the same active ingredients as Victoza, an FDA-approved drug for the treatment of Type 2 Diabetes Mellitus. After verifying the patient’s diagnosis, Emry liaised with the PBM to obtain necessary prior authorization criteria for Victoza and worked with the prescribing physician to initiate the prior authorization process.

Outcomes

With the successful prior authorization process, the member was switched to Victoza, the right drug for managing diabetes, at a cost of $0 per month – an annual savings up to $14,760. By coordinating with the insurance provider, we ensured the medication was covered under the member’s plan. This proactive benefit navigation approach not only secured necessary approvals but also eliminated out-of-pocket expenses for the member.

This case exemplifies how Emry’s comprehensive healthcare navigation services can effectively reduce financial burdens for members by ensuring their medications are fully covered.

Total Savings:

$14,760

Topics

Rx Prior Authorization

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