CASE STUDY: Managing the costs and health of a patient with Rheumatoid Arthritis
Putting Patients First: A Collaborative Approach to Managing Rheumatoid Arthritis and Reducing Costs.
In today’s healthcare landscape, success is no longer measured solely by the medication filled or dollars saved. It’s measured by the outcomes achieved and the lives improved. That’s why the partnership between ClearScript and Fairview Specialty Pharmacy stands out. Together, we united cost-containment strategies with deeply personalized care to help a health plan member living with Rheumatoid Arthritis (RA) regain control of her life, while delivering meaningful savings for the plan.
Patient-Centered, Value-Driven Care
At 45 years old, the member faced debilitating RA that left her struggling to open jars, climb stairs, or even enjoy time with her family. Her RAPID3 score, a measurement tool used to assess disease severity, was 20 (on a scale of 0-30) and indicated high disease activity, and her pain was a constant 7 out of 10. Her quality of life was slipping away. She was prescribed Humira®, a biologic commonly used for RA.
But the path to better health required more than medication. It needed a coordinated approach that combined strategic benefit management with hands-on patient support.
Cross-Functional Care in Action
ClearScript’s formulary strategy prioritizes clinically effective, cost-efficient therapies on the preferred tier, including biosimilars like Hadlima®, which deliver comparable clinical benefits at a lower cost. Working in lockstep with this strategy, Fairview engaged the patient directly to ensure a smooth, confident transition to the biosimilar.
Fairview Specialty Pharmacy provided:
- Regular counseling and recaps through Fairview Link text messaging, the member’s preferred channel of communication. This ensured that she was well-informed about her treatment plan and could easily communicate with her healthcare team.
- Strategically timed follow-ups to track her progress, promote adherence, and identify potential issues early.
- Proportion of Days Covered (PDC) tracking to ensure high adherence (result: PDC = 0.96) and provide monitoring support for the member’s healthcare team.
- Comprehensive biosimilar education and personalized support that built trust in the biosimilar’s safety, effectiveness, and benefits.
- Whole person support through enrollment in an employer-sponsored Wellbeing program to support mental and physical health
Outcomes That Matter
This collaborative approach yielded remarkable results:
| RAPID3 score | 20 to 5 (high to low disease activity) |
|---|---|
| Pain score | 7 to 3.5 |
| Daily activity | Full return without difficulty |
| Medication | Smooth transition to Hadlima |
| Financial impact | Significant cost savings without compromising care |
Beyond the Pill: A Smarter Model of Specialty Care
This case study demonstrates the power of aligning strategic formulary management with compassionate pharmacy care. ClearScript brings market intelligence and formulary-driven strategies that lower costs and promote high-value care. Fairview Specialty Pharmacy provides the direct patient connection, proactive follow-up, and personalized education that drive adherence and positive outcomes.
Amplifying the Impact
At ClearScript and Fairview Pharmacy Services, we’re not just aligned, we’re united in a mission: cut costs, end waste, improve outcomes, and make every member’s experience exceptional.
Our organizations are continuing and strengthening our partnership to fast-track the shift to cost-saving biosimilars. We’re closely tracking market pricing in real time, quickly identifying savings, and moving members through a smooth, coordinated transition.
The result? Members get the care they need, health plans save, and we prove that doing what’s right for patients is also what’s smart for the bottom line.