Rebecca is a single mother of two children and suffers from Crohn’s disease. A part of her treatment includes a regimen of infusions administered at a medical facility.
Aside from Rebecca suffering from an uncomfortable condition, managing a full-time job, and dropping off/picking up her youngest child from daycare, she also travels to a treatment center two hours away from home to receive her infusion.
So why the long commute? Her medication must be administered by a medical professional.
Our clinical team knows something Rebecca doesn’t. Her commute is actually unnecessary. Her medication is billed with a J Code designation. J Codes are not billed as a pharmacy insurance cost, but as a medical insurance cost, which is much higher. Through our True Codes program, we can shift her infusion from a J Code to an item billed through her pharmacy insurance, thus providing more location options at a lower cost.
Through True Codes, our nurse navigators work with the patient and doctor, with the same or better patient care.
J Codes is a hot topic right now because of the high cost many employers are paying through the medical benefit. The solutions around it have to be applicable. - Daniel Wilson, PharmD, BCPS, Director of Clinical Operations, True Rx Health Strategists
In Rebecca’s case, we found an infusion center closer to home and she has the same copay. Rebecca’s employer saves $145,000 annually.
This is just one example of how our True Codes program optimizes the care and convenience of the patient, while reducing costs for the employer.
Solutions have to be clinically minded and they have to come from a team of experienced clinicians who understand the drugs, understand what is appropriate for those medications, and make sure the patient is receiving good quality of care while controlling those costs. — Daniel Wilson, PharmD, BCPS, Director of Clinical Operations, True Rx Health Strategists
True Codes savings are significant when managing the astronomical cost of specialty treatments for employees on a self-funded plan.
True Codes is one of many levers True Rx Health Strategists can pull to identify hidden paths to savings for the employer and improve convenience for the patient.