A smarter way to protect the plan — and protect the people behind it.
Anderson Community Schools has a clear opportunity to reduce prescription drug spend while removing medication cost as a barrier for employees and families. RxProtect identifies high-cost brand and specialty medications already impacting the plan, then creates a white-glove path to lower-cost access and better member affordability.
This is not a theoretical wellness idea. These are actual medications, actual claims, actual plan dollars, and actual member costs that can be attacked immediately.
The opportunity is already sitting inside the claims data.
The Anderson Community Schools prescription analysis shows a concentrated group of high-cost medications creating a major financial burden for the plan and, in many cases, for members. RxProtect's model focuses on these specific medications and members — not the entire population — allowing the plan to create meaningful savings without disrupting the broader pharmacy benefit.
When the additional Crysvita, Wakix, Kisqali, and Ilumya opportunities are incorporated, Anderson Community Schools' modeled RxProtect opportunity increases from approximately $921,000 to more than $1.25 million annually.
The most important finding is that these savings are concentrated among a very small number of medications and members, allowing the district to create significant financial impact without disrupting the broader pharmacy benefit.
A very small percentage of prescriptions are driving a very large percentage of pharmacy spending.
Key Insight: A very small percentage of prescriptions are driving a very large percentage of pharmacy spending. RxProtect focuses on this concentrated area of spend, allowing Anderson Community Schools to achieve significant savings without disrupting the medications used by the vast majority of members.
When medication cost becomes a burden, health outcomes suffer.
For school employees and their families, medication affordability is not just a benefit-plan issue. It becomes a real-life issue. When members delay refills, skip doses, or stretch medication because of cost, conditions can worsen. That can lead to more medical claims, more absenteeism, more stress, and a lower-quality benefits experience.
- Lower plan spend
- Reduce member out-of-pocket cost
- Improve medication access
- Support adherence
- Create a better benefits experience
- Avoid broad plan disruption
Rebate-adjusted savings calculator
Some plans receive rebates on certain brand medications. This tool allows Anderson Community Schools to model the savings opportunity after accounting for estimated rebate value.
This calculator is designed to pressure-test the opportunity. Even when rebates are considered, the goal is to compare the true net cost of the current path against the total RxProtect script cost and member affordability impact.
The biggest opportunities hiding inside the data.
A small number of medications represent a disproportionately large share of the total opportunity.
CRYSVITA
Crysvita alone represents one of the largest opportunities identified in the entire analysis. A single therapy creates nearly a quarter-million dollars of annual savings opportunity while simultaneously reducing member financial burden.
WAKIX
A high-cost specialty therapy where RxProtect pricing creates substantial plan savings while preserving member access.
KISQALI
This oncology medication represents both meaningful plan savings and one of the largest member affordability improvements identified in the analysis.
ILUMYA
Although the plan savings opportunity is smaller, the member affordability impact is significant and highlights the value of removing cost as a barrier to treatment.
The savings are concentrated in a small number of medications.
| Medication | Scripts | Plan Paid | RxProtect Cost | Client Savings | Member Savings | Why It Matters |
|---|---|---|---|---|---|---|
| CRYSVITA | 0 | $543,451 | $303,289 | $240,162 | $9,443 | Single largest opportunity — nearly a quarter-million in annual plan savings |
| TRIKAFTA | 11 | $300,581 | $259,985 | $27,199 | $5,000 | High-cost specialty therapy with major plan exposure |
| ENBREL | 27 | $186,518 | $58,125 | $86,024 | $14,527 | Strong specialty savings opportunity |
| KISQALI | 0 | $168,475 | $138,310 | $30,164 | $16,777 | Oncology medication with substantial member affordability impact |
| COSENTYX | 18 | $122,183 | $52,200 | $46,889 | $3,300 | Significant inflammatory-condition savings |
| DEXCOM G7 SENSOR 90-day | 91 | $104,127 | $75,985 | $18,855 | $0 | Diabetes management cost-control opportunity |
| KESIMPTA | 13 | $100,920 | $42,575 | $39,091 | $9,001 | High-impact specialty savings |
| OZEMPIC | 101 | $85,816 | $45,563 | $26,969 | $12,018 | GLP-1 opportunity with member affordability impact |
| DUPIXENT | 12 | $83,061 | $56,206 | $17,993 | $4,634 | Specialty medication with recurring savings |
| MOUNJARO 7.5MG | 86 | $82,483 | $61,117 | $14,315 | $7,662 | GLP-1 opportunity |
| KISQALI 400DOSE | 7 | $81,092 | $33,775 | $31,702 | $15,001 | High member-cost relief opportunity |
| WAKIX | 0 | $68,049 | $27,247 | $40,802 | $800 | High-cost specialty therapy with substantial plan savings |
| ILUMYA | 0 | $23,008 | $16,972 | $6,035 | $9,860 | Smaller plan savings, but significant member affordability impact |
This is where the story becomes human.
The analysis shows an estimated $269,952 in member-paid medication cost that can be removed — $233,072 originally identified plus an additional $36,880 from Crysvita, Wakix, Kisqali, and Ilumya. For employees and families, this is not an abstract number. It is money coming directly out of household budgets for medications that may be necessary to manage chronic or serious conditions.
Out-of-pocket cost already being absorbed by employees and families — including $36,880 in newly identified relief from Crysvita, Wakix, Kisqali, and Ilumya.
Targeted programs eliminate or significantly reduce the patient cost of eligible medications.
One-on-one support, guided enrollment, refill coordination, and direct member assistance.
The opportunity spans multiple disease states.
Specialty / Inflammatory
These medications are often among the highest-cost recurring therapies in the plan.
Diabetes / Metabolic
Better affordability can support better adherence and stronger disease control.
Oncology / Complex
These claims are high-cost, sensitive, and require a careful member-first approach.
Migraine / Neurological
Targeted savings exist beyond traditional specialty categories.
Respiratory / Maintenance
Savings can extend into recurring maintenance therapies where adherence matters.
Targeted. Personal. Built around the member.
- 1
Claims Review
RxProtect reviews actual pharmacy claims to identify eligible medications and savings opportunities.
- 2
Target List Creation
Only members on specific high-cost medications are included. No broad disruption to the plan.
- 3
Member Outreach
Members receive white-glove support through calls, texts, emails, letters, and a guided enrollment process.
- 4
Medication Access
RxProtect coordinates the medication access process and refill support.
- 5
Reporting
Anderson Community Schools receives clear reporting on enrollment, medications delivered, plan savings, and member savings.
- 6
Ongoing Optimization
New claims data is reviewed regularly to identify new savings opportunities.
This is not a PBM replacement. This is precision cost containment.
How to explain this simply.
Anderson Schools has nearly $3M in plan-paid prescription spend represented in this analysis.
RxProtect identifies specific high-cost medications where the district may be overpaying.
The updated modeled analysis shows more than $1.25M in client savings opportunity.
The analysis also shows nearly $270K in member cost that can potentially be removed.
Crysvita alone accounts for over $240K of the plan savings opportunity.
This program does not require a full PBM change.
This program focuses on a small percentage of members creating a large percentage of the opportunity.
The goal is not just lower cost. The goal is lower cost, better access, and a better benefits experience.
A practical path to launch.
- 1Confirm target medication list
- 2Approve communication strategy
- 3Build Anderson-specific member education page
- 4Begin outreach to eligible members
- 5Track enrollment and refill progress
- 6Report savings monthly or quarterly
- 7Refresh claims data regularly
Schedule a 30-minute review with RxProtect.
Validate rebate assumptions, finalize the medication target list, and confirm the launch strategy for Anderson Community Schools.