Our Approach to Specialty

Individualized Care for Members With Complex Conditions

Specialty medications are helping to treat a number of rare, serious and complicated conditions, such as hepatitis C, multiple sclerosis and cancer. While these medications provide a new level of hope for the people who require them, they are expensive and complex. 

A Comprehensive Approach to Specialty Care

Elixir’s thoughtful approach to specialty care is unique to each specialty condition and carefully considers clinical effectiveness, member experience and economic impact. To achieve optimal outcomes, we focus on four strategies:

• Condition-focused clinical controls that are disease and drug specific, with balanced utilization management and formulary controls, and offers best practices in care management
• Individualized care from our expert specialty pharmacy team that engages the member and their providers from initial prescription throughout their treatment, providing specific care pathways
• Process integration with the specialty pharmacy to coordinate care, reduce complications and efficiently manage transactions
• Meaningful data with insights and recommendations to identify risks and cost-savings opportunities, close gaps, and tailor member communication and support

The Right Specialty Pharmacy for the Condition

Elixir’s approach to specialty also includes a unique specialty network as well as our own in-house specialty pharmacy, Elixir Specialty. 

Specialty Network: Realizing that there are unique drivers for various specialty medication classes and that each specialty pharmacy manages these classes differently, with some having better expertise in certain classes than others, we have developed a network of specialty pharmacies that are selected as the best in managing their respective therapeutic categories of specialty drugs.

Every two years, we complete a rigorous proposal process for this network. Our process covers:

• Standard Operational Services - Includes dispensing standards such as accurate and timely deliveries
• Clinical Support - Looks at how patients are cared for by therapeutic class, if they observe adherence, track side effects and monitor disease progression
• Outcomes Management – Includes reporting on key metrics to measure improvement in patient care and outcomes
• Costs – Pharmacies must offer aggressive discounts to be part of our specialty network

We work closely with this prestigious network to provide a high level of clinical support, maximize treatment success, minimize adverse reactions, and ensure adherence to the prescribed medication therapy.

Elixir Specialty Provides Individualized Care and Cost Management

Our own Elixir Specialty is a valued part of this Specialty network, providing expert care to members with a number of complex conditions. Elixir Specialty has developed a comprehensive care model, led by a dedicated team of certified specialty and often disease-certified pharmacists. Our condition-focused approach centers on compassionate patient advocacy and waste avoidance, with a comprehensive knowledge of available treatments to ensure proper care coordination. 

Beyond simply dispensing the medication, Elixir Specialty offers a high-touch, personalized care experience for all patients. We identify opportunities to monitor progress, listen to patient concerns, and provide clinical interventions that drive optimal outcomes and plan savings. 

Through pharmacy-driven utilization reviews, assessments prior to the first delivery and targeted interventions throughout treatment, our clinicians are engaged with both the patient and the physician care team to ensure the best possible therapy management and care coordination. As a nationally recognized URAC- and ACHC-accredited specialty pharmacy, Elixir Specialty brings care, convenience and expertise directly to the patient with our comprehensive care model.