Quantum Health Launches Premier Pharmacy Navigation Solution to Help Employers Contain Growing Pharmacy Costs

Quantum Health, the leading consumer healthcare navigation and care coordination company, announced today it has expanded its specialty pharmacy services to continue helping self-insured employers and plan members save money. The new Premier Pharmacy navigation solution leverages the expertise of Quantum Health’s clinical pharmacy team which advises members on cost-effective care under their medical benefit, to now guide to cost-effective, clinically equivalent alternatives under their pharmacy benefit as well.

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Prescription medications remain the fastest-growing component within employee health benefits, with specialty drugs rising by more than 10% in 2023, according to Mercer’s 2023 National Survey of Employer-Sponsored Health Plans. Industry estimates point to approximately 50 new specialty drugs entering the market this year, and controlling drug costs will continue to challenge employers and their employees. Drugs, like biosimilars, which have been making headlines for their potential to increase competition and decrease costs, are a primary focus of Quantum Health’s Premier Pharmacy solution. In the MedCity News and Quantum Health annual “The INDEX” benefit consultant survey, 28% of healthcare benefits consultants reported they are recommending pharmacy spend management to improve employers’ healthcare spend, and 61% of consultants are advising clients more often on drug cost and pricing strategies.

Quantum Health’s Premier Pharmacy navigation solution is built upon the company’s core navigation and existing specialty pharmacy capability that today supports over 500 self-insured employer clients and over 3 million members. Its established specialty pharmacy capability includes utilization management and a site-of-care program combined with its proprietary Real-Time Intercept^® capability and in-house Pharmacy Services team comprised of doctors, pharmacists and analysts to intercept members earlier in their care journeys to offer high-value, clinically appropriate medication alternatives. Quantum Health’s highly credentialed care team collaborates with providers to direct members to curated options at the onset of a care journey to ensure that the treatment is optimized clinically and financially through a tailored, educational process that is less disruptive to the member. This model provides members with the best healthcare experience, along with allowing them and the employer to get more value from their benefits savings.

A 2023 study of over 200 Quantum Health employer clients and 1.8 million members found that the use of the company’s navigation platform achieved a 91% success rate in shifting the site of care for members’ specialty drug treatment. Quantum Health’s ability to conduct site-of-care medication reviews across its member base helps ensure members receive the most clinically appropriate, high-value care while also helping plan sponsors save $2.08 per member per month on specialty drug costs.

“Quantum Health is committed to expanding our efforts in managing specialty medication costs,” stated Zane Burke, CEO of Quantum Health. “By enhancing our strategies and extending our reach to the point of prescription, we aim to provide the most appropriate, high-value care from the start. While specialty medications make up a small percentage of prescriptions, they account for roughly 50% of total pharmacy spend. Our unique view into these trends through our health benefits navigation platform allows us to proactively engage with providers and direct members to the appropriate medication and best health outcomes at the lowest possible cost while also helping our employer clients address these unsustainable cost trends.”

Quantum Health’s Premier Pharmacy Navigation Solution Key Features:

Member Identification – using claims, formularies and clinical criteria, Quantum Health applies its proprietary algorithms with its core navigation platform and Real-Time Intercept to identify more drug-level intervention opportunities.

Value-Based Intervention – by offering safe, effective and appropriate therapeutic alternatives for costly specialty medications, Quantum Health delivers a high value on investment.

Member Education and Support – equipping members with crucial insights, Quantum Health’s pharmacy support team guides members to the next, best action in their healthcare journey.

Provider/Prescriber Outreach – actively educating providers and facilitating new prescriptions for the member, the Quantum Health pharmacy services team ensures members receive the most effective treatment options available.

Learn more about Quantum Health’s approach to pharmacy and its new Premier Pharmacy navigation solution: https://quantum-health.com/pharmacy/

About Quantum Health

Quantum Health celebrates its 25th year as the industry-leading consumer healthcare navigation and care coordination company that delivers an unparalleled consumer experience to its members, as well as validated claims savings and high satisfaction rates for its self-insured employer and payer clients. Quantum Health’s proprietary Real-Time Intercept^® capability identifies opportunities for early intervention in a member’s healthcare journey, resulting in better engagement, outcomes and cost efficiencies.

Founded in 1999 and based in Dublin, Ohio, Quantum Health has earned numerous awards and honors, including being named among the Fastest-Growing Private Companies by Inc. 5000, a Great Place to Work by FORTUNE Magazine and Entrepreneur Magazine, and one of FORTUNE’S Best Workplaces in Healthcare. The Women Presidents’ Organization has also ranked Quantum Health as one of the 50 Fastest-Growing Women-Owned/Led Companies for over 15 years.

To learn more about the company, visit Quantum-Health.com, and connect with us on LinkedIn and Twitter.

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“By enhancing our strategies and extending our reach to the point of prescription, we aim to provide the most appropriate, high-value care from the start," stated Zane Burke, CEO of Quantum Health