EmpiRx Health Lowers Drug Spend in Mental Health

EmpiRx Health CEO Karthik Ganesh discusses how the PBM was able to decrease mental health drug spending at a time when utilization is increasing.

Despite an increase in utilization of medications to treat mental health disorders between 2020 and 2021, EmpiRx Health’s drug spend for commercial payers actually decreased. Overall, behavioral health categories drove an increase of 9.4% in pharmacy claims year-over-year. EmpiRx Health saw a decrease of 4.7% in plan paid per utilizer.

The decrease, EmpiRx Health CEO Karthik Ganesh told Formulary Watch in an interview, is a result of the PBM’s value-based approach to healthcare.

“Everything that we do is in concert with the physician,” he said. “Trained pharmacists have critical conversations with the physician about clinically appropriate yet lower-cost alternatives. They help to optimize alternatives for that patient, presenting the clinician with a compelling case study or a case summary.”

Ganesh said the pharmacists are an extension of the patient’s care team. “They have an 88% engagement rate with physicians,” Ganesh said. “These results are directly correlated to our pharmacists being able to convince clinicians to go with a clinically appropriate yet lower-cost alternative.”

EmpiRx uses analytics and AI technology to create a tailored approach for managing a population of patients. Applying this approach to mental and behavioral health medication has led to a decreased drug spend. Specific to anti-depressants, while year-over-year utilization increased by 12%, EmpiRx saw a decrease in gross spend per claim by 1.8%.

Specific to attention deficit/hyperactivity disorder (ADHD), adults over the age of 26 have driven a consistent increase in treatment for more than three years, now accounting for 50% of all ADHD utilizers. Overall ADHD utilization increased by 20.2% year over year, countered by a 9.1% decrease in gross spend per claim.

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Ganesh said EmpiRx’s patient population is diverse and mirrors the United States in terms of race, ethnicity, gender, and age, as well as demographic and social and economic factors.

EmpiRx has developed an AI that uses the Johns Hopkins ACG System, which is population health analytics software that uses diagnosis, pharmacy and lab data, and big data tools. The PBM then creates a risk profile to identify personal risk factors.

In 2019, the PBM has developed a complex care management model that includes mental health. The AI system identifies patients who are high risk, who have comorbidities, have called the company two or more times, have been prescribed an antidepressant or a history of opioid abuse to be part of the complex care model. This care model provides patients with a care coordinator to help them manage their care and medications.