Member Cost Avoidance: Rx Prior Authorization

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.

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.

Savings

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.

Topics

Rx Prior Authorization

Get started with Emry

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Member Cost Avoidance: Rx Prior Authorization

Situation

Service Provided

Savings

Topics

Get started with Emry

Suggested Case Studies

Healthcare Navigation: Maximizing the Value of Employee Benefits With Emry Health

High-Cost Bill Review: Out-of-Network Hospital Admission ​

Bill Review and Negotiation: Patient Saves $4,750

High-Cost Bill Review: Out-of-Network Hospital Admission