Case Study: a large healthcare client saves more than $5M with EXL digital pharmacy solutions

How digital solutions saved more than $5m for a healthcare client’s specialty pharmacy group

EXL worked with a large healthcare client to help its specialty pharmacy group manage a high volume of pre-certification requests while also simplifying a costly and complex distribution, administration, and patient management environment. The client needed to reduce turnaround times, support both commercial and Medicare plans, comply with contractual and state requirements, and improve experiences for members and providers.

EXL implemented a digital, multi-pronged management program that digitally sorted and routed faxed prior authorization forms, automated specialty medication pre-certification, standardized nurse-led clinical reviews, and streamlined provider phone requests to identify complete forms and those needing outreach. As a result, the healthcare organization’s specialty pre-certification and pharmacy group saved more than $5 million annually for five consecutive years, with both commercial and Medicare plans contributing to the impact.