A general contractor in Wisconsin had an employee diagnosed with chronic Crohn’s disease. Also known as an inflammatory bowel disease (IBD), Crohn’s disease causes inflammation of the digestive track, which leads to severe side effects and requires regular treatments.
The employee was receiving an Entyvio injection every eight weeks to help reduce the inflammation caused by IBD. The Entyvio injection was administered at a local ambulatory surgery center (ASC) convenient to the employee’s home, but still required travel and cost $14k per injection. Because the cost of the Entyvio injection was so high, the reinsurance carrier added a laser—increasing the specific stop loss premium for that member.
“…reduced cost for the employer while simultaneously allowing the member a better treatment experience by delivering the care at home.”
Point C looked into alternatives for the employee’s care. Specialty pharmacies and home infusion were the target, as they could reduce cost for the employer while simultaneously allowing the member a better treatment experience by delivering care at home. Point C also worked with the reinsurance carrier on a plan to have the laser removed.
The Entyvio injection was complicated due to the rules of the laser, so the employer and employee worked together to move the treatment to a gastrointestinal (GI) specialist at a reduced cost. Once the laser was removed, a specialty pharmacy took over administering the injection at the employee’s home, recognizing a 57% savings per injection.