Hospital outpatient facilities are substantial cost drivers for specialty medications billed under the medical benefit. In fact, outpatient settings are often the most costly sites of care.
To find out just how much more costly these sites of care were, we analyzed MarketScan* database information, for a 12-month period, which included 47.2 million patients, and 302.8 million total medical drug claims.
Accredo researchers found overall outpatient claims are significantly more expensive than the average cost of a claim from an in-home setting:
- Claims for immune deficiency drugs were more than double the cost at outpatient settings when compared to the average in-home claim.
- Remicade® (infliximab), one of the most utilized drugs to treat inflammatory conditions, costs an average of 70% more when billed from an outpatient setting.
- Rare disease claims – specifically Alpha-1 outpatient claims – cost an average of 17% more per claim.
While MarketScan’s data doesn’t provide the drug unit detail, separate analysis of medical claims by Express Scripts demonstrates this high cost trend is consistent on a per unit basis as well.
Accredo Convenient Care
Accredo helps plans control site-of-care spending across many specialty conditions. The Accredo Convenient Care program moves medical specialty spending in expensive outpatient facilities to lower cost sites of service, such as the home setting.
Through ongoing reporting, plans see significant savings per claim. Most importantly, patients experience convenience and lowers costs through home-infusion with the support of local Accredo nursing staff, 24/7 access to a pharmacist and ongoing patient care management from clinicians that specialize in their disease state.
Savings in Action
One payer who launched Accredo Convenient Care conducted outreach to 27 patients who had been receiving Remicade and immune globin infusions at outpatient facilities or physician offices and offered a transition to in-home care.
Of the 27 patients, 15 of them transitioned to in-home care, saving the plan 46% on drug spending for immune disorders and 22% for drugs to treat rheumatoid arthritis and other inflammatory conditions. This led to an overall savings of $787,680 over one year.
To learn more about Accredo Convenient Care please contact your Express Scripts or Accredo representative.
*”The MarketScan databases contain inpatient and outpatient medical/surgical data stored in four tables: Inpatient Admissions, Inpatient Services, Facility Header, and Outpatient Services. The data come from a selection of large employers, health plans, and government and public organizations. The MarketScan Research Databases link paid claims and encounter data to detailed patient information across sites and types of providers and over time. The annual medical databases include private-sector health data from approximately 350 payers”.
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