Specialty Drug Cost Management Service (Payer Matrix)

Our specialty drug cost management service targets the spiraling expense of pharmaceuticals.

Through our partnership with Payer Matrix, a healthcare cost containment business, we are able to offer large national, middle market and small corporate groups a robust program that enables plan sponsors and their members/employees to gain access to alternate forms of funding for specialty drugs.

Our Specialty Drug Cost Management Service:

Target Market—Self-funded plans with 200+ covered employees
Lowers and/or limits liability for Stop Loss
Advocacy model that successfully procures alternative funding for high cost drugs thus reducing the cost to the plan
Medication list includes over 300 drugs (1500 NDC’s) for various chronic conditions
Savings based fees: if the Plan Sponsor doesn’t save then Payer Matrix doesn’t get paid
Align primary, secondary and tertiary payer options in order to reduce out of pocket costs to plan sponsors and plan members
Leverage knowledge and robust data pertaining to alternate funding programs, regulatory requirements, and cost savings programs

Plan Sponsors and Members Benefit From:

An average 50% reduction in specialty spend
Impacts only 2-4% of members
Customized responsive medication access model that ensures plan members receive their specialty drugs in a timely manner
A proven process of detailed on-boarding, the signing of service level agreements, the assigning of a designated point person, auditing of a plan’s existing specialty drug cost-savings potential and user’s impact, and thorough communications plan to keep you and your members fully-apprised of next steps
Member eligibility confirmation, member explanation and enrollment in alternate funding programs, and specialty drug acquisition
Patient interaction is managed by professional staff who are all clinicians (nurses, pharmacy technicians, pharmacists)
Normal reimbursement turnaround is 7 business days

+100^%Per capita drug spending on specialty drugs doubled from 2014-2019*
15^%Specialty drug price inflation for 2020 is predicted to be 15 percent**
+50^%Projected cost of specialty drug spend by 2022 as a percentage of overall drug spend*

**2020 Segal Health Plan Cost Trend Survey

Founded in 1943, Amalgamated Life Insurance Company has since grown into a leading provider of comprehensive insurance solutions operating in all 50 states and the District of Columbia. The Company provides competitive group products including Term Life, Medical Stop Loss, Disability and Specialty Drug Cost Management, as well as voluntary products such as Accident, Accidental Death & Dismemberment, Critical Illness, Dental, Disability, Hearing, ID Theft, Legal, Portable Term Life and Whole Life, among others.

Since 1975, Amalgamated Life Insurance Company has consistently earned the “A” (Excellent) Rating from A.M. Best Company attesting to its strong fiscal position and claims paying abilities. The Company is a member of the Amalgamated Family of Companies; which includes: a third party administrator, Amalgamated Employee Benefits Administrators; Amalgamated Medical Care Management, a medical care management firm; Amalgamated Agency, a property and casualty broker; and AliGraphics, a printing firm.

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