Specialty Drug Cost Management
Our specialty drug cost management service targets the spiraling expense of pharmaceuticals because 2-4% of members are placing 80% of the population’s claims; which are impacting the entire fund. Through our partnership with Payer Matrix, a healthcare cost containment business, we are able to offer large national, middle market and small corporate groups, and Taft-Hartley Funds 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, typically averaging a 50% reduction
- 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 you do not pay
- Turn-Key Program—Aligns primary, secondary and tertiary payer options in order to reduce out of pocket costs to plan sponsors and plan members
- Fees capped at $50,000
Plan Sponsors and Members Benefit From:
- 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