You already know the problem: specialty pharmacy is consuming a growing share of employer healthcare spend, and even the most disciplined transparency, sourcing, and utilization strategies aren’t enough to keep up with the growing pipeline of biologics. Specialty medications can be lifesaving, but come with challenges: high costs, variable effectiveness, and potential for harm. Because these therapies are highly targeted, they often aren’t effective for every patient. Ethicos Health’s AI-Enabled Clinical Efficacy Platform reduces pharmacy spend for PBMs and their clients by replacing Prior Authorization with outcome-based evaluation – identifying high-cost drugs that aren’t delivering results, cutting waste on treatments that don’t produce outcomes, and getting patients to the right therapy faster. By continuously monitoring longitudinal patient data against clinical endpoints, we empower PBMs to determine whether a medication is clinically effective for each member, providing clear insight into what matters most: is the medication working? By continuously assessing patient data against clinical guidelines, eliminating ineffective therapies, and “gold carding” members on the right ones, PBMs reduce both pharmacy spend and trend for their clients, while lowering their own administrative costs and allowing their clinicians to practice at the top of their license.

As a health plan, you are currently paying $50K – $300K+ per patient annually for many specialty drugs. For many specialty drugs, 20 – 40% of patients either never respond or lose response over time. Yet coverage systems mainly verify eligibility, not clinical outcomes. We’ve been working with several plans on a different model. Ethicos Health’s AI-Enabled Clinical Efficacy Platform reduces specialty and other high-cost pharmacy spend for plan sponsors by replacing Prior Authorization with outcome-based evaluation – identifying high-cost drugs that aren’t delivering results, cutting waste on treatments that don’t produce outcomes, and getting patients to the right therapy faster. By continuously monitoring longitudinal patient data against clinical endpoints, we empower health plans to determine whether a medication is clinically effective for each member, providing clear insight into what matters most: is the medication working? By continuously assessing patient data against clinical guidelines, eliminating ineffective therapies, and “gold carding” members on the right ones, plans reduce specialty pharmacy spend, improve clinical outcomes, lower administrative costs, and deliver a far better overall experience.

Ethicos helps TPAs expand their offerings while addressing one of the fastest-growing cost concerns for employers. We create demonstrable client savings, strengthen employer retention and differentiate your solution in competitive RFPs by integrating sophisticated capabilities that ensure your clients only pay for specialty medications that work. Ethicos reduces specialty and other high-cost pharmacy spend for plan sponsors by replacing prior authorization with outcome-based evaluation — identifying high-cost drugs that aren’t delivering results and getting patients onto the right therapy faster. Our platform is flexible and can address pharmacy or medical Rx spend, or both. TPAs can apply it directly to medical Rx – the physician-administered and infused specialty drugs billed under the medical benefit — to address the 30–40% of total drug spend that isn’t managed by a PBM. TPAs with an owned or affiliated PBM can extend it across pharmacy benefit specialty spend as well.