WHAT OUR CLIENTS ARE FACING
As of 2020, specialty drugs now account for over 50% of total pharmacy spend, and in 2021 alone, the FDA approved 50 new medications with an average cost of $185k.
WHAT OUTSIDE VENDORS ARE DOING
Most “Patient Assistance” vendors charge a percent of savings, with some being as large as 30%.
HOW IT WORKS
- A carve-out of specialty medications from the employer-sponsored health plan through the Summary Plan Document
- Enrollment of members in patient assistance programs provided by drug manufacturers.
- Members who qualify receive their medication direct from the manufacturer at $0.
- Members who don’t qualify will have their medication brought back on to the health plan. They will still pay $0.
- Plan pays a small flat PMPM fee rather than a percent of savings.
- Medications will have grace fills allowed to ensure no gaps or delay in coverage for your members.
- 1,200 member life group saw a $700K in savings.
- 5,500 member life group saw a $1.5 Million in savings.
- 90 member life group saw a $265K in savings.
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