Specialty High-Dollar Claim Review Program: Launch Date & Pilot Savings

Emily Torgerson  •   September 30, 2020

The week is finally here! Our specialty high-dollar claim review program launches this Thursday, October 1. This program will focus on reviewing indication-specific dosing of specialty medications and optimizing dose regimens for efficiency. Our Cooperative pharmacists will assess all specialty claims above $10,000 to identify and resolve issues at no additional cost to members who opt into the program.

This past July, we implemented a pilot program for 10 of our member groups. The pilot proved what we expected to see, and we have substantial savings to share.

Results from 10 Member Specialty High-Dollar Claim Review Program Pilot

Annualized plan savings of $305,000

Annualized plan cost avoidance of $1.2 million

The Cooperative will have more than 200,000 lives participating in the specialty high-dollar claim review program as of January 1, 2021. We will also continue our non-specialty high-dollar claim review program, reviewing claims in excess of $1,500.

National CooperativeRx’s mission is to assure our members have access to high-quality, cost-effective prescription drugs and services. If your plan wishes to implement the program and has not already done so, or if you have any questions, please contact your National CooperativeRx account manager.