How One Health System Secured $55 Million and Reached the Patients Referrals Were Missing

Background

A centralized Medication Assistance Program team sits at the heart of that mission. Seven pharmacy technicians support 200 clinics across two Northwestern states and more than half a million patients, including everything dispensed through the system's charity pharmacy. The pharmacy carries prescriptions for chronic disease alongside a heavy load of high-cost specialty medications for serious, life-limiting illness.

Challenge

Out-of-pocket costs keep climbing, and patients who cannot afford their prescriptions leave them at the pharmacy counter. The way most health systems find these patients makes the problem worse. Identification depends on referrals from the care team, which is reactive by design, so the patients at highest financial risk are often never flagged at all. Providers tend to catch high-cost infusion patients, but primary care patients slip through until they reach the pharmacy, see the price, and walk away. The downstream cost is real: missed doses, worse outcomes, more hospitalizations, and unpaid bills that turn into bad debt.

The MAP team felt all of this at once. It was monitoring hundreds of assistance programs by hand, re-entering duplicated application data, running a separate charity pharmacy, and chasing fund-expiry deadlines, with close to 200,000 patients in active treatment a year. Spreadsheets tracked the work, but they gave leadership no real view into productivity and no way to justify a bigger team.

Solution

The health system deployed TailorMed Core to scale the program and make its results visible. Onboarding ran through the COVID-19 shutdown, and TailorMed's high-touch model carried it: a discovery period to set client-defined goals, meaningful success metrics, integration and data validation with existing systems, and one-on-one training.

From there, the team moved from reactive to proactive. TailorMed Core surfaces the patients with the highest out-of-pocket costs, tracks renewals before funding lapses, and integrates with Epic to give a complete, timely view of each patient without manual data entry. Advanced filters let the team build targeted lists by diagnosis, medication, provider, facility, and team member.

Benefits investigation clarifies coverage and out-of-pocket estimates, matches patients to foundations, copay assistance, and free or replacement drug programs, and pre-populates enrollment forms. Just as important, the platform connected clinical pharmacy to finance, turning the team's work into annual projections leadership could actually use.

Results

• 2,234 patients assisted and 3,170 program enrollments in a single year
• $55M in funding secured through reduced drug spend and added revenue
• Results on pace to grow 50% the following year, with the team expanded and a Center of Excellence built to carry the model to other regions

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