A targeted group of 248 prescriptions represents more than $711,000 in combined plan and member cost. RxProtect identifies a pathway to reduce that cost by approximately $318,632 while eliminating the member expense associated with these medications.
DeKalb County Central United School District does not need to disrupt every prescription in its pharmacy benefit to create a meaningful financial result.
The savings opportunity is concentrated within a targeted group of high-cost and high-impact medications.
| Financial Metric | Current State | RxProtect Result | Savings |
|---|---|---|---|
| Plan-paid prescription cost | $590,742.03 | $392,699.08 | $198,042.95 |
| Member-paid prescription cost | $120,589.10 | $0.00 | $120,589.10 |
| Combined plan and member cost | $711,331.13 | $392,699.08 | $318,632.05 |
The RxProtect result includes the estimated RxProtect shared-savings fee reflected in the source analysis.
The value of the RxProtect opportunity extends beyond the district’s pharmacy budget. Under the RxProtect pathway, member-paid costs represented in this analysis could potentially be eliminated for participating members.
This is not simply a plan-cost strategy. It directly removes prescription expenses from employees and their families.
A small number of medication categories drive most of the financial result — enabling a focused, not disruptive, pharmacy strategy.
of the combined savings opportunity comes from seven medication categories.
of the entire combined savings opportunity comes from just two medications.
| Medication | Claims | Net Client Savings | Member Savings | Combined Savings | Share | Type |
|---|---|---|---|---|---|---|
| Stelara | 12 | $65,547 | $51,074 | $116,621 | 36.6% | Specialty Biologic |
| Skyrizi | 8 | $20,202 | $26,518 | $46,720 | 14.7% | Specialty Biologic |
| Orencia | 4 | $16,500 | $10,030 | $26,530 | 8.3% | Specialty Biologic |
| Mounjaro | 72 | $19,532 | $3,120 | $22,652 | 7.1% | High-Volume Metabolic |
| Lenalidomide | 4 | $9,022 | $9,246 | $18,268 | 5.7% | Specialty Oncology |
| Entyvio | 8 | $4,755 | $10,120 | $14,875 | 4.7% | Specialty Biologic |
| Xifaxan | 12 | $10,230 | $480 | $10,710 | 3.4% | High-Cost Brand |
Stelara is the defining opportunity in the DeKalb Central analysis. Only 12 prescriptions produce more than one-third of the entire identified savings result.
| Claims | 12 |
| Current plan paid | $169,497.42 |
| Current member paid | $51,074.22 |
| RxProtect medication cost | $71,666.77 |
| Net client savings | $65,546.54 |
| Member savings | $51,074.22 |
| Combined savings | $116,620.76 |
| Combined savings per claim | $9,718.40 |
Skyrizi demonstrates the importance of evaluating both plan cost and member cost. The member impact is greater than the direct client savings represented by this medication.
| Claims | 8 |
| Current plan paid | $83,392.84 |
| Current member paid | $26,517.84 |
| Net client savings | $20,202.40 |
| Member savings | $26,517.84 |
| Combined savings | $46,720.24 |
| Claims | 4 |
| Current plan paid | $33,383.60 |
| Current member paid | $10,030.08 |
| Net client savings | $16,499.95 |
| Member savings | $10,030.08 |
| Combined savings | $26,530.03 |
| Combined savings per claim | $6,632.51 |
Mounjaro produces lower savings per prescription than the highest-cost specialty medications, but the volume of prescriptions makes it an important component of the overall opportunity.
| Approximate claims | 72 |
| Net client savings | $19,531.70 |
| Member savings | $3,120.00 |
| Combined savings | $22,651.70 |
Filter, search and sort the full opportunity set by category, cost and savings.
| Medication | Claims | Plan Paid | Client Savings | Member Savings | Combined▼ | Type |
|---|---|---|---|---|---|---|
Stelara 90 mg/mL | 12 | $169,497 | $65,547 | $51,074 | $116,621 | Specialty Biologic |
Orencia ClickJect 125 mg/mL | 4 | $33,384 | $16,500 | $10,030 | $26,530 | Specialty Biologic |
Skyrizi 150 mg/mL NDC 00074105001 | 4 | $41,696 | $10,101 | $13,259 | $23,360 | Specialty Biologic |
Skyrizi Pen 150 mg/mL NDC 00074210001 | 4 | $41,696 | $10,101 | $13,259 | $23,360 | Specialty Biologic |
Mounjaro (aggregate) | 72 | $68,000 | $19,532 | $3,120 | $22,652 | High-Volume Metabolic |
Entyvio Pen 108 mg/0.68 mL | 8 | $29,537 | $4,755 | $10,120 | $14,875 | Specialty Biologic |
Lenalidomide 15 mg NDC 00480124421 | 2 | $15,109 | $8,381 | $4,623 | $13,004 | Specialty Oncology |
Xifaxan (aggregate) | 12 | $24,800 | $10,230 | $480 | $10,710 | High-Cost Brand |
Tremfya 100 mg/mL | 2 | $13,378 | $3,329 | $4,051 | $7,380 | Specialty Biologic |
Lenalidomide 15 mg NDC 70710103308 | 2 | $15,309 | $641 | $4,623 | $5,264 | Specialty Oncology |
Jardiance 25 mg | 14 | $7,200 | $2,640 | $840 | $3,480 | High-Volume Metabolic |
Trelegy Ellipta | 10 | $6,800 | $2,700 | $720 | $3,420 | High-Cost Brand |
Nurtec ODT | 6 | $5,400 | $2,500 | $720 | $3,220 | High-Cost Brand |
Xarelto 20 mg | 10 | $5,800 | $2,350 | $600 | $2,950 | High-Cost Brand |
Trintellix | 8 | $4,200 | $1,790 | $480 | $2,270 | High-Cost Brand |
Qulipta | 4 | $3,600 | $1,650 | $480 | $2,130 | High-Cost Brand |
Ubrelvy | 4 | $3,200 | $1,420 | $400 | $1,820 | High-Cost Brand |
| Totals for filter | 178 | — | $164,166 | $118,879 | $283,045 |
Match the highest-impact medication opportunities to eligible members using secure claims and eligibility data.
Provide personalized member education explaining the opportunity, process, safety standards, and potential elimination of member cost.
Assist the member and prescriber throughout enrollment, prescription coordination, delivery, and ongoing refill management.
Track enrollment, medications delivered, plan savings, member savings, and total realized financial impact.
The strategy is voluntary, targeted, measurable, and designed around the member experience.
Bubble size = plan-paid cost. Upper-left = low volume, extremely high impact. Upper-right = high volume, high aggregate impact.
The opportunity is concentrated within a targeted group of high-cost prescriptions. The 248 prescriptions included in this analysis represent approximately $711,331 in combined plan and member cost.
RxProtect identifies a pathway to reduce that cost by approximately $318,632 after its shared-savings fee. DeKalb Central retains an estimated $198,043 in net client savings, while employees and their families avoid approximately $120,589 in prescription expenses.
The greatest opportunities are concentrated in medications such as Stelara, Skyrizi, Orencia, Mounjaro, Lenalidomide, Entyvio, and Xifaxan. These seven medication categories generate approximately 80% of the total identified savings.
Stelara and Skyrizi alone represent approximately $163,341 in combined savings, or more than half of the entire identified opportunity.
This creates a focused and measurable strategy: identify the members associated with the highest-impact medications, provide a voluntary and supported transition experience, eliminate member cost, and allow DeKalb Central to capture savings that already exist inside its pharmacy data.
Only 248 prescriptions are included in the analysis.
The opportunity creates approximately $198,043 in net client savings.
Employees and their families could avoid approximately $120,589 in prescription costs.
Seven medication categories generate approximately 80% of total identified savings.
The next step is to identify the members connected to the highest-impact medications and begin a supported, voluntary implementation strategy.