Consumer / Employer, Health Tech

Quantum Health Launches New Pharmacy Navigation Solution for Employers

Quantum Health launched its Premier Pharmacy navigation solution on Tuesday. The solution helps members find safe and effective therapeutic alternatives to expensive medications.

Quantum Health, a healthcare navigation company, launched its new Premier Pharmacy navigation solution to help lower prescription drug costs for self-insured employers, the company announced Tuesday.

Dublin, Ohio-based Quantum Health offers navigation and care coordination services for employers, including claims assistance, point solution referrals and utilization management. It supports more than 3 million members and 500 employers.

The new Premier Pharmacy solution relies on the company’s clinical pharmacy team. The solution has a member identification feature, which uses claims and other data to find more drug intervention options. It also has a value-based intervention feature, which provides safe and effective therapeutic alternatives to expensive medications. In addition, members receive ongoing education and assistance from the pharmacy support team, and Quantum reaches out to providers to inform them of new prescriptions for members.

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

“When we think about what we’re uniquely qualified to do, it’s these complex problems because we have people that are trained in healthcare,” said Scott Doolittle, chief financial officer of Quantum Health, in an interview. “We have people that understand the pharmacy benefits, they understand the drugs. We have pharmacists on staff. We also sit at the intersection of the provider and that member experience. So we’re handling all the inbound volume from the providers and we’re working with the members to make sure that they get the care they need.”

The Premier Pharmacy solution builds on the company’s existing core navigation and specialty pharmacy services. This includes utilization management services, which evaluate the necessity of treatments, and the company’s site-of-care program, which determines the most cost-effective location for administering a specialty drug (as cost varies by location).

Prescription drug costs are a major challenge for employers right now. About 92% of employers are worried about high-cost drugs in the pipeline and 91% are concerned about the pharmacy cost trend overall, according to a 2023 survey from the Business Group on Health. The survey also found that pharmacy costs represented 24% of employers’ overall health spend in 2022.

“The goal for this product is to offer another way to help our customers combat rising trend with something that is complicated to administer but actually at face value makes a ton of sense,” Doolittle said.

Quantum Health’s launch of the Premier Pharmacy solution comes after a series of announcements made by the company. In March, the company launched a navigation offering for Medicare Advantage plans and a partnership with Vanderbilt Health Affiliated Network. It also recently expanded its Comprehensive Care Solutions Platform, a platform of benefits solutions its employers can contract with, to include Progyny and Kindbody.

Other companies that offer healthcare navigation services include Accolade and Health Joy.

Photo: cagkansayin, Getty Images