Without guidance, healthcare is costly and complex. While Quantum’s care coordination
services
are typically reserved for employers with >1,000 employees, Pareto members benefit from
exclusive, negotiated access to their best-in-class navigation platform.
In 2020, we assumed lead responsibility for simplified Quantum administration and
billing. The
result? One consistent price across all employer groups.
A strong finish to Q4:
Between 10/1/20 and 1/1/21, we brought 61 new accounts onto Quantum. This
equates to
another 10,000 enrolled employees—bringing our total count to 85 employers and
15,000
employee lives.
Pareto-Specific Formularies
How do we steer the right people, to the right drugs, in the right dosages? By
leveraging best
practice plan design and curating a smaller universe of appropriately priced drugs.
To curtail unnecessary spending on expensive drugs with low clinical value, we
introduced
Pareto-specific formularies. Coverage parameters are driven by philosophy/comfort level:
Low control: Few restrictions and exclusions; many drugs are covered
Medium control: More restrictions and exclusions; 5% additional average savings
High control: Most restrictions and exclusions; 10% additional savings on
average
Specialty Rx Carve-Out
Our new specialty carve-out solution through Archimedes Rx solves three problems:
Climbing specialty Rx costs are too clinically and financially complex to be
managed at
the traditional pharmacy benefit manager (PBM) level
Traditional PBMs have little incentive to tackle specialty Rx
As an employer, you have insufficient data at your disposal to effectively hold
PBMs
accountable
As an independent PBM partner, Archimedes offers a seamless solution that integrates:
Clinical oversight
Alternative funding
Bolt-on programs (with a SmithRx and Magellan Rx benefit)
Third-Party Administrator
(TPA) Placemats
We rolled out partnerships with our first round of core TPAs to:
Streamline superior plan design
Integrate disparate pieces that should all work in tandem