vendor
CuraFi is dedicated to helping payors in Medicare and Medicaid understand, manage, and ultimately control drug costs. We aren’t a PBM, we aren’t just a consultancy, and we aren’t another VBA company promising savings “some time in the future.” We work with our clients to evaluate drug spend using proprietary machine learning and extensive data sources to identify products that are being utilized above trend, and then focus on how those drugs are prescribed, filled, and used by beneficiaries.
This extensive knowledge, combined with expert clinical assistance, beneficiary cost responsibility analysis, and practice management support, allows CuraFi to support Medicare payors by:
1) Helping ACO REACH and MSSP plans move to less cost intensived rugs in part B to achieve similar or superior outcomes by utilizing a legally approved mechanism to ensure specialist physicians outside of the network are not financially disadvantaged by using appropriate, lower cost medications;
2) Facilitating ACO REACH and MSSP plans ability to utilize Part D coverage of drugs also used in Part B to increase their savings while not disadvantaging plan members financially; and,
3) Managing Part B and D spending exposure in Medicare Advantage by taking full or shared upside-downside risk within Part D in what used to be the “coverage gap” that plan sponsors in 2025 now have significant additional financial risk.
For Medicaid payors – MCOs and ACOs – CuraFi will be working with ACAP member plans to develop a holistic approach to coverage and payment for High Cost, Low Use (HCLU) medications that can cost millions of dollars. CuraFi is the only company that has all of the Medicaid data for every beneficiary since 2019 that has had a claim for greater than $10,000; this knowledge is allowing us to build an actuarially sound model for plans and state payors to help manage the financial risk of these high value drugs and biologics. Using this actuarially sound design, we hope to build a business model that allows Medicaid ACO and MCOs to better serve their members by mitigating and managing the financial variations these products create in plan MLRs.
Contact:
Jeff Myers
Head of Payor Relations
1501 Mariposa Street, Suite 428
San Francisco, CA 94107
202.329.9770
jeff@curafi.com
www.curafi.com