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

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