The Edge

When great minds come together, client relationships thrive. That is especially true with CastiaRx Account Management, recently expanded with the addition of Tammy Tarzynski as Director, leading the Chicago team. Together with Joel Efken, Director of Account Management in St. Louis, she collaborates to ensure consistency, effective solutions, process enhancements and impressive results in all areas that touch clients.

Tammy is a veteran of some of the nation’s best-known healthcare companies. She has a 27-year track record of strategic and tactical leadership within the healthcare space, with her most recent 20 years in the PBM industry. Tammy joined CastiaRx from Pharmastar PBM where she was Director of Business Development. Her previous experience – with companies such as CVS Caremark, CIGNA, Navitus Health Solutions and Prime Therapeutics – includes equal amounts leading account management and sales.

“I am fortunate to have a breadth of experience in client relationships,” Tammy explains. “On the sales side, I learned to work with consultants, brokers and TPAs to closely connect with their goals and concerns. In managing accounts, it’s essential to understand the innerworkings of PBM and client relationship essentials such as contracts and financials. There is tremendous value in both backgrounds.”

In partnership with Tammy, Joel applies broad PBM experience, technical and operations expertise to deliver key services to clients. With more than 30 years in the healthcare industry, Joel has been instrumental in the company’s management and operations leadership and strategy, helping to shape the CastiaRx information, pharmacy and financial systems; client support processes; and process improvement activities. Joel and Tammy’s knowledge of the lifecycle of prescription processing and fulfillment proactively impacts our approach to identifying client trends and implementing solutions.

The team has also recently welcomed Iris Elkind as an Account Manager based in our Chicago office. Iris has a background that includes 12 years of pharmacy benefit experience. Together, the Account Management team is proactively consultative with clients, not just in benefit design but in trend management, clinical management and internally, working across CastiaRx departments to ensure client needs are anticipated and met.

For patients with complex medical conditions, starting a new drug therapy can be difficult. “Some patients find that due to side effects or other complications, they need to stop therapy or switch to a different drug or dose after a short trial period,” says Valerie Woerndle, Director of Clinical Operations. “This can be expensive and wasteful for both the plan and the patient.”

Coming late fall, the CastiaRx Split Fill program powered by Diplomat addresses the costs of these medications by offering a 2-week supply for an initial 1-3 months, rather than the typical 1-month fill. “This approach allows the patient to try the medication to assess tolerance before the plan incurs the full cost for a month’s supply,” Valerie says. “It also results in higher clinical interventions for patients who need to start new drug therapies, with patients benefiting from the additional, high-touch attention.”

The Split Fill program is only offered to clients who have CastiaRx exclusive specialty through Diplomat Specialty Pharmacy. Medications chosen for this program typically have a high discontinuation rate with adverse side effects, offering prime opportunities for savings and enhanced patient support.

Clients with a patient transitioning to one of these drugs could achieve cost savings of $5,000-10,000 during just 1 year. With average cost avoidance per split fill treatment of $3,112, the program has the potential to make a big difference for clients – and for patients who are embarking on their first fill of these medications.

When a brand drug goes off patent and its generic comes to market, savings are generally in store for the plan and the member. After Pfizer’s patent for the nerve pain drug, Lyrica, ran out in late June 2019, the FDA authorized 9 different companies to produce generic versions – and they are already on the market.

Behind-the-scenes, when a brand goes generic, the CastiaRx formularies are reviewed to determine the proper tier for the new generic version(s). Client communications such as Immediate Releases may be issued and stored on our Clinical Corner to help clients stay current on the latest details around timing, pricing, formulary placement and other insights – read our Lyrica Immediate Release. In certain circumstances, members utilizing the medication may be notified about the availability of generics and related formulary changes.

As always, we are focused on keeping members informed and helping them understand and properly use their medications. When a generic becomes available, our formulary considers it preferred. On behalf of the plan, we help transition utilization to the lower-cost generic version, in the manner that the plan dictates. Some clients choose not to cover the brand drug if a generic is available, but others may take a different approach. Some plans may have a consumer preference fee that would still allow a member to choose a brand name drug and pay the difference in cost.

In all matters brand or otherwise (safety recalls, new drug announcements and cost insights), our Clinical Corner is your go-to destination for details. Bookmark Clinical Corner and check it frequently!

Fall is in the air and plan changes are on the horizon. It is that time of year again when many organizations make changes to their annual pharmacy benefit plan. To allow time to accommodate all requests, plan changes should be submitted in writing by October 31 to give staff adequate time to meet your needs.

Our goal is to make this process smooth and efficient for our clients and their members by implementing all benefit changes and running quality testing prior to the effective date. We will do our best to accommodate all change requests received after October 31, but cannot guarantee the implementation date. Now is the time to talk with your account manager about solutions that will help you reach your goals!