{"id":2146,"date":"2021-05-21T14:32:15","date_gmt":"2021-05-21T14:32:15","guid":{"rendered":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/?page_id=2146"},"modified":"2025-05-06T16:13:15","modified_gmt":"2025-05-06T20:13:15","slug":"specialty-drug-cost-management-service-payer-matrix","status":"publish","type":"page","link":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/specialty-drug-cost-management-service-payer-matrix\/","title":{"rendered":"Specialty Drug Cost Management"},"content":{"rendered":"<p>Our specialty drug cost management service targets the spiraling expense of pharmaceuticals because 2-4% of members are placing 80% of the population\u2019s 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.<\/p>\n<h4 class=\"wp-block-heading\">Our Specialty Drug Cost Management Service:<\/h4>\n<ul class=\"wp-block-list\">\n<li><strong>Target Market<\/strong>\u2014Self-funded plans with 200+ covered employees<\/li>\n<li>Lowers and\/or limits liability for Stop Loss, typically averaging a 50% reduction<\/li>\n<li>Advocacy model that successfully procures alternative funding for high cost drugs thus reducing the cost to the plan<\/li>\n<li>Medication list includes over 300 drugs (1500 NDC\u2019s) for various chronic conditions<\/li>\n<li><strong>Savings based fees<\/strong>\u2014if the Plan Sponsor doesn\u2019t save then you do not pay<\/li>\n<li><strong>Turn-Key Program<\/strong>\u2014Aligns primary, secondary and tertiary payer options in order to reduce out of pocket costs to plan sponsors and plan members<\/li>\n<li>Fees capped at $50,000<\/li>\n<\/ul>\n<h4 class=\"wp-block-heading\">Plan Sponsors and Members Benefit From:<\/h4>\n<ul class=\"wp-block-list\">\n<li>Customized responsive medication access model that ensures plan members receive their specialty drugs in a timely manner<\/li>\n<li>A proven process of detailed on-boarding, the signing of service level agreements, the assigning of a designated point person, auditing of a plan\u2019s existing specialty drug cost-savings potential and user\u2019s impact, and thorough communications plan to keep you and your members fully-apprised of next steps<\/li>\n<li>Member eligibility confirmation, member explanation and enrollment in alternate funding programs, and specialty drug acquisition<\/li>\n<li>Patient interaction is managed by professional staff who are all clinicians (nurses, pharmacy technicians, pharmacists)<\/li>\n<li>Normal reimbursement turnaround is 7 business days<\/li>\n<\/ul>\n<div class=\"wp-block-group pdf-footer\">\n<div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p>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 &amp; Dismemberment, Critical Illness, Dental, Disability, Hearing, ID Theft, Legal, Portable Term Life and Whole Life, among others.<\/p>\n<p>Since 1975, Amalgamated Life Insurance Company has consistently earned the \u201cA\u201d (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.<\/p>\n<\/div>\n<\/div>\n<p class=\"pdf-footer-note\">The information in this product sheet is in an abbreviated form only. The actual coverage and amounts are subject to all the terms, limitations and exclusions in the policy. If the information in this product sheet differs from the Specialty Drug Cost Management Policy, the terms of the policy govern.<\/p>\n<p><a href=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-content\/uploads\/sites\/3\/2025\/05\/specialty_drug.pdf\" class=\"cta\" target=\"_blank\" rel=\"noopener noreferrer\">Download the PDF<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Our specialty drug cost management service targets the spiraling expense of pharmaceuticals because 2-4% of members are placing 80% of the population\u2019s 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&#8230;  <a class=\"excerpt-read-more\" href=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/specialty-drug-cost-management-service-payer-matrix\/\" title=\"Read Specialty Drug Cost Management\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-2146","page","type-page","status-publish","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/pages\/2146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/comments?post=2146"}],"version-history":[{"count":6,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/pages\/2146\/revisions"}],"predecessor-version":[{"id":4497,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/pages\/2146\/revisions\/4497"}],"wp:attachment":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-life\/wp-json\/wp\/v2\/media?parent=2146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}