The $400K signal: What six months of Leap data says about the specialty drug trend

An employer offering a self-funded health plan came to Leap facing double-digit specialty trend, driven largely by therapies like Ocrevus, Darzalex Faspro, and Keytruda. 

The reason that trend runs so far ahead of the rest of medical spend is not the drugs themselves. It is buy-and-bill markup, the practice of billing a single bundled claim that hides the drug cost, the administration fee, and the provider's margin behind one allowed amount.

Leap's claims analysis for this employer found markups running as high as 400%, with some members' medications marked up by as much as $250,000 a year, on top of the personal cost of long commutes and missed work their members were already experiencing.

The six-month result

Just six months after launching, Leap is delivering $400,000 in annualized savings per 10,000 covered lives. And member engagement is still ramping up. The employer is on track to reach $800,000 saved per 10,000 lives by year-end, as outreach shifts from broad activation toward engaging the smaller subset of members who account for a disproportionate share of specialty drug spend.

The member-level numbers back up the trajectory. The employer's Net Promoter Score sits at 100, against an industry average of roughly 30. Member satisfaction is 98%. And 80% of members who connected with a Care Guide chose Leap to support their infusion care.

There are a variety of engagement levers that can be pulled to drive savings. Among employers with Leap, those who:

• Relied on passive enrollment typically saw 10% to 20% member utilization.
• Provided financial incentives saw member utilization rates of 35% to 40%.
• Embedded Care Guide consultations directly into the prior-authorization process pushed utilization past 60%. 

This employer's result reflects the value of engagement levers.

Tangible efforts that moved the needle

The employer and Leap built a thoughtful activation strategy, which included: 

• Co-branded announcements and webinars that put Leap where members already go to find care.
• Integration with a navigation partner so referrals happen at the point of need.
• A custom prior-authorization flow to expedite decisions. 
• Financial incentives including waived copays.

How one family experienced better care

One of this plan’s employees received Gammagard infusions for a rare autoimmune disease. Twice a month, she and her husband would drive two hours round-trip to an infusion center. The husband took two half-days off work on back-to-back days every other week to support her. Between the drive, the waiting room, and insurance approvals, infusion day had become stressful in ways that went well beyond her own recovery.

Within a few weeks of launching Leap benefits, she was receiving the same Gammagard infusion at home, on a schedule built around her schedule, with no copay. 

A Leap Care Guide:

• Handled the prior authorizations.
• Coordinated medication shipments.
• Kept treatment on schedule so the family didn't have to manage it themselves. 

As the member put it: "I've been an IVIG patient for several years and dealt with many companies. Leap by far has been the most reliable, and I owe them gratitude because if it wasn't for them, I would not be able to do my day-to-day life as I am able to today."

When price transparency and the employee experience meet

This is what 80% Care Guide conversion and 98% satisfaction can look like. The savings figure and the member experience contribute to the same outcome.

Transparent pricing creates the opportunity, but engagement is what turns that opportunity into realized savings and satisfied members. The employer that gets members to a Care Guide earlier is the employer that captures the larger savings number.

Want to see what this looks like against your own claims data?