Advancing pharmacy: a new model

August 01, 2022 | Download PDF

Pharmacy care needs to work for today’s consumers. People are tired of the complexities and frustrations that surround their pharmacy experience. They need a new model that meets them where they are, to help transform those experiences and improve overall health outcomes.

CarelonRx is reimagining pharmacy care and transforming how it’s impacting people’s lives with our newest innovation, virtual pharmacy. Virtual pharmacy will move beyond the traditional transactional experience with a new distribution model that will deliver a digital-first, concierge-level pharmacy experience to members. It will give members confidence in every moment of health.

The CarelonRx journey so far

Since our inception, CarelonRx has explored new pharmacy distribution models to meet our members where they are. Our acquisition of ZipDrug in 2020 was a steppingstone toward our upcoming virtual pharmacy model. We’re now able to connect our members with local pharmacies for coordinated refills, multidose packaging, specialized clinical education, and scheduled hand delivery. These services help our members overcome barriers to medication adherence, including transportation and scheduling challenges.

Our members and clients benefit from data-driven, pharmacy care decisions. A recent review found that a group of members using ZipDrug partnered pharmacies reduced their overall medical costs by $66 per member, per month (PMPM).* These members went to the emergency room less often, needed fewer inpatient hospital admissions, and were 10% more adherent with medications for hypertension, high cholesterol, and diabetes.

What is our newest innovation, virtual pharmacy?

CarelonRx’s virtual pharmacy will address barriers members encounter when trying to fill their prescriptions, such as:

  • Uncertainty about insurance coverage and prescription costs.
  • Delays in filling and receiving their medication due to staffing or inventory issues.
  • Trips to the pharmacy while feeling sick.
  • Additional steps when prior authorization or step therapy is needed.

With virtual pharmacy, we can streamline the relationships between members, doctors, and pharmacists. When a prescription is written and sent over, we will immediately know the member’s identity. We can promptly alert them that their prescription was received and inform them of the cost and any savings opportunities. When additional steps such as prior authorization are required, our virtual pharmacy will already have the necessary drug list and coverage information. We can use this combined medical and pharmacy data to quickly help — sometimes without needing to call the doctor.

“We’re offering the best of mail, retail, and what specialty pharmacies offer today, and we’ll have access to information that they don’t,” says Darren Gettings, CarelonRx Vice President and Chief Supply Chain Officer. “It’s about optimizing the way pharmacy care should be delivered, based on the member’s needs.”

The bottom line

Our newest innovation, virtual pharmacy, will make the pharmacy experience simpler and more affordable, helping to close care gaps and improve clinical outcomes and adherence, all while lowering medical costs. Most importantly, this strengthens our commitment to improve members’ whole health.