Vativorx: Beyond a Conventional Pbm Program

Vativorx: Beyond a Conventional Pbm Program

Lisa Quarterman, CEO & Managing Partner, VativorxLisa Quarterman, CEO & Managing Partner, Vativorx
Every great business entrepreneur has an exciting and inspiring origin story to tell. For Lisa Quarterman, that story began in 1996 when her sister with special needs redefined resilience and sedulousness for her. “Inspiration” became more than just a term when Lisa witnessed her sister struggle and become successful through certain programs. In quiet introspection, Lisa asked herself, “If she can manage this journey on her own, then what’s stopping me?” That’s precisely when she decided to leverage her numerous years of experience in the workers’ compensation space and create a difference for not only the workers’ compensation patients, but for the insurance industry as a whole, both from financial and technology standpoints. The genesis of Cypress Care—a provider of health cost management solutions and strategies for the Medicare, workers’ compensation, and auto insurance markets in the US—was a natural progression to further her resolve to “make her mark.”

As fate would have it, Cypress Care reached stellar heights and was acquired by OptumRx—the third-largest pharmacy benefits management (PBM) in the world. This acquisition allowed Lisa, a mother of three, to take a break from the corporate life and relish the joys attached to motherhood. Waltzing through these years, she soon realized that no other job is as difficult as parenting. Lo and behold, she figured out running a multimillion-dollar organization was what she was cut out for. Primed for fresh challenges, Lisa rebounded to her corporate life in 2016—this time recreating the same magic in the government healthcare space. Ever since, Lisa has been connecting dots—a relentless pursuit of innovation that has eventually evolved into what is now VativoRx—a company that brings in innovative pharmaceutical benefits management.

When it came to setting the foundation for VativoRx—a name that translates to “Innovative Company” in Italian— Lisa’s approach was unconventional, to say the least. She was admittedly driven by the goal to bring in a new, out-of-the-box technology that creates a difference and makes things faster, smarter, and more innovative. Despite starting with a bare cupboard—pertaining to its services—VativoRx has gradually climbed up the ladder presenting its clients with all the qualities they look for in a PBM company.

Challenging the Status Quoz

Within four years of inception, VativoRx stands at the forefront of the industry as a true alternative to the status quo in PBM. The company equips its clients with full service, innovative, leading solutions in PBM that combine the scale and purchasing power of the largest providers and the flexibility and agility of the smaller ones. A specific domain where the company is currently focused on is specialty drugs. The persistent trend toward specialty medicine stands to reason that these medications not only bring potential life-changing clinical benefits to patient health but also have profound implications for payers, providers, pharmacies, and life sciences segments. While the recent innovations in the medical field have increased the number of specialty drugs, they have also contributed to the upward trend in specialty drug spending. As this specific challenge in the realm of specialty drugs can limit patient access, industry players continue to seek ways to manage specialty pharmaceutical costs. Their search ends with VativoRx, an expert that acts as the first line of defense against rising prescription drug costs.

Built on proven industry business experience, VativoRx is in a class by itself when it comes to delivering innovative services and solutions for PBM. From eligibility management, eligibility verification, and claims processing to clinical service, and pharmacy network management, the company brings in a plethora of PBM capabilities to the table. The 100 percent women-owned company is committed to serving middle-market organizations, third-party administrators, hospice organizations, small and large employer groups, government, and HMOs with PBM custom-designed to address the unique needs and goals of each organization and its members. In doing so, VativoRx banks on technology and innovation for delivering a suite of PBM services to enterprises of all shapes and sizes.

A New Dimension in PBM

With Lisa at the helm as the CEO and managing partner, VativoRx leverages innovation as a tool to gain an edge in the market and deliver a fast, simple, effective solution with proven results. “Innovation allows us to be creative with the suite of services that we provide as opposed to delivering a standard cookie-cutter offering. It also helps us to streamline the entire process and build plans that are not only cost-effective but also customized to meet the needs of each member in an organization,” says Lisa. Besides addressing the unique needs and goals of each organization and its members, these drug prescription programs are also designed keeping in mind the fiduciary responsibilities of an organization.


Innovation allows us to be creative with the suite of services that we provide as opposed to delivering a standard cookie-cutter offering

As a full-service and innovative solutions provider in the PBM landscape, VativoRx has developed a clinical program with step therapy and prior authorizations to be on the top of any patient’s total care by suggesting them less expensive alternatives. The company designs and manages prescription benefit programs that provide cost savings on formulary and non-formulary drugs, accommodate patients with advanced formulary and distribution options, and deliver services through technologically superior systems. “We suggest the clinical teams to refrain from spending a hefty amount of money at the onset or on prescription drugs, which can take over the cost of somebody’s medical care,” informs Lisa. The company manages patients’ prescription medication care to avoid the occurrence of further medical costs on hospitalization or long-term physician visits. For bringing down the cost of specialty management, besides developing clinical programs, VativoRx also builds relationships with different specialty pharmacies across the country to help streamline the services and educate the patients on their medical conditions, thereby reducing the additional medical costs associated with specialty medicines and post-medication care.

Paving the Path to Success

VativoRx’s senior management counts more than 100 years combined in pharmacy operations and pharmacy benefits management. This rich expertise plays an instrumental role in treating each of its clients differently, by assessing their individual financial or technology needs, alongside what they want to offer to their customers. To design a customized benefits plan for every single client, VativoRx offers a suite of solutions, suggestions, a clinical team, along with a team of pharmacists and business analysts. Post an introductory meeting of these teams with the members of the client organization, the company meticulously assesses and determines their needs before designing a benefits plan.

When it comes to implementing the programs, VativoRx goes through a rigorous process with the ultimate goal of fully and electronically integrating back-and-forth eligibility, prescription management, billing, communication, prior authorizations, and the step therapy. VativoRx works with the clients as a partner each step of the way, making sure that the benefits package designed goes out to each individual member, and each prescription is not only filled correctly but is taken correctly and works correctly. For a client with an existing PBM in place, VativoRx performs an impact analysis by loading 90 to 120 days’ prescription history of the members into its system. This is followed by determining if they are going to be impacted by VativoRx’s network, co-pay pricing, and new formularies. “We communicate our results to the client before we go live, and determine if we need to target patients with enhanced education and outreach,” adds Lisa.

She goes to highlight a customer success story wherein a particular client with an existing PBM was struggling with network penetration. The other apparent struggle for the client was the expenses associated with specialty medications. VativoRx stepped in and converted a part of the client’s specialty medication to less expensive alternatives. Besides, VativoRx’s pricing with the specialty vendors also significantly reduced the financial impact. As a result, the client could save approximately $150,000 in one quarter in pharmacy with the aid of the step therapy program implemented by VativoRx.

VativoRx’s ascension to success is governed by Lisa’s rich expertise and a knack for unlocking the true potential of PBM capabilities. As an accomplished entrepreneur with a record of successfully implementing PBM programs for large self-insured organizations for close to two decades now, there is little that Lisa hasn’t encountered. As someone whose career has experienced a meteoritic rise through various serendipities, she firmly believes in empowering women—also a critical competency of the firm in which she takes the most pride. Today, having inspired numerous women entrepreneurs, Lisa has rightfully earned the love of her adorable kids, support of her family, respect of her peers, and, most importantly, a rewarding career. She actively supports women who wish to return to their dream career, that they may have opted to quit due to the challenge of managing it alongside a growing family.

Continuing to script success stories for the clients, Lisa is leading VativoRx with a strong focus on expanding the business, both from growth and product offering perspectives. With a strong presence in Atlanta, GA and Miami, FL, VativoRx will be commencing its sales operations in the North-east and the West Coast. Besides, the company will be launching a campaign for responding to the government needs this year. VativoRx will also release a proprietary software product that will allow the company to integrate with the pharmacies and customers on an adjudication platform, cutting down the requirement of outsourcing. Moving ahead, the company is looking to raise capital to bring about more innovations, while Lisa’s focus is wedged on fostering partnerships in the industry and identifying opportunities for VativoRx to expand its service offerings within the healthcare space.

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Vativorx

Company
Vativorx

Headquarters
Atlanta, GA

Management
Lisa Quarterman, CEO & Managing Partner

Description
VativoRx manages patients’ prescription medication care to avoid the occurrence of further medical costs on hospitalization or long-term physician visits. For bringing down the cost of specialty management, besides developing clinical programs, the company builds relationships with different specialty pharmacies across the country to help streamline the services and educate the patients sufficiently about their medical conditions, thereby reducing the additional medical costs associated with specialty medicines and the post-medication care attached to it. As opposed to the standard cookie-cutter offerings, VativoRx takes care of the pharmaceutical clients’ fiduciary responsibility of giving its employees, and customers access to discounted medication