Payor of Care

Are you a payor of care?

For employers, insurance carriers, Pharmacy Benefit Management (PBM) organizations, Pro-GeneX combines the MyBestMed® genetic panel with clinical support to maximize employee and patient safety while minimizing costs.

The cost of an adverse drug reaction is a heavy price to pay. We believe in helping doctors to find the right drug with the correct dose.

Effects of Rising Prescription Drug Costs

Many drugs have become so costly that people may not refill a prescription when needed. Whether this be a flat-out refusal to pay high prices or out of lack of financial ability, the fact remains that high drug costs make it more likely that a patient will not receive their medications.

This leads to a ripple effect; patients that are not compliant with medication treatment often require additional visits to their physician of care, hospital ER visits, or, worse, hospitalization. Again, in 2016, one in seven adults in the United States did not refill a prescription due to costs and that number is even higher when the patient has multiple health issues or prescriptions.

This figure does not factor in the long-term costs and effects of not taking maintenance medications and/or the possibility of the patient ending up with a long term care situation resulting from an issue such as a heart attack or stroke.

Effect of Rising Medication Costs on Employers and Insurers

Employers also feel the impact when trying to budget cost-effective insurance plans for their employees. The unstable cost of drugs, combined with the fluctuating utilization by consumers, wreak havoc on payrolls and benefit plans. As drugs are prescribed and dosages altered, so too change the costs to employers and insurance plans. There are many variations to drugs prescribed to patients due to a “trial-and-error” prescribing approach, where doctors make their best recommendations when it comes to what will work best for a patient. This, of course, leads to higher consumer and employer costs.

Insurance companies feel the impact of medication cost changes. Insurers have difficulties negotiating with government agencies and insurance providers to get the best result for their expenditure. The goal of the insurance company is to provide a positive experience for their clients to maximize client retention. This becomes more difficult as prescription prices continue to rise.

The uninsured, who must take the self-pay route, are at the highest risk of over-paying for prescriptions;

There are no negotiations when it comes to prescription drug costs. There are “drug club cards” that can help reduce the cost for those who self-pay, however, the reality is most cannot afford the medications they truly need. So what, then, is the answer to all these rising medication costs?

Reducing costs from adverse drug events

Adverse Drug Event Costs

2 MILLION people are hospitalized each year from preventable adverse reactions to prescription medications

$3.5 billion per year in extra medical costs because of Adverse Drug Events

700,000 emergency department visits annually

100,000 emergency hospitalizations annually

Estimated 5% of high risk Medicare beneficiaries hospitalized each year due to ADEs

50-75% of Adverse Drug Events costs are preventable

Solutions for Rising Prescription Costs

Genomic testing is the beginning in solving problems associated with rising prescription medication costs. Your genetic make-up holds the key to what medications are right for you based on your genetic profile. Pro-GeneX Laboratories analyzes a DNA sample, collected by a simple cheek swab, using state-of-the-art processes. Coupled with up-to-date prescription information, the proprietary RXGeneAlert™ risk management system gives your clinician the confidence to prescribe medications based on DNA profiles versus the guesswork used today. In real-time, The RXGeneAlert™ risk management system is constantly updated as warnings are issued, and new research is uncovered.

Benefits of Pharmacogenetics and Pro-GeneX

The MyBestMed® clinical panel provides the broadest gene panel available to the market today. A central database provides a streamlined portal for patients, caregivers, physicians and pharmacists to work together to deliver the best patient care.

· The current trial-and-error prescribing, or wait and see process of prescribing medication, can be greatly reduced to save the patient time and money. Patients no longer worry about new prescription safety or waste money on prescriptions that don’t work.

· Physicians have the best tools at their fingertips to help diagnose the patient and prescribe a better-informed prescription.

· Pharmacists can be better informed of potential medication risks and make the best recommendations.

· Caregivers can monitor patients from our user-friendly portal that provides important insights to clinicians to prevent adverse drug events.

· Long Term Care faculties can improve patient care and resident satisfaction by optimizing treatment based on their genetic makeup.

· Hospitals, patients, employers and health insurers benefit from reduced readmissions caused by adverse drug events that result in improved
patient experience.

Pro-GeneX offers the science to establish a medical profile for each patient that indicates the most efficacious medications that result in savings to the consumer, healthcare provider, insurance company, and the hospital.

There is a great deal to discuss regarding PGx and a payor. Finding a good starting point to consider is contacting us.

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