March 2019

Reducing Member and Plan Sponsor Liability for Prescription Drugs

3/18/2019 4:42:57 PM
How leveraging coupons and copay cards can save some serious money
By Peter Beerman, Senior Vice President, HealthSmartRx Solutions
For many Americans, the high cost of specialty drugs continues to be a growing concern. Pharmaceutical manufacturers continue to promote and distribute coupons and copay cards to members to assist with the high cost of specialty drugs. The idea is to reimburse insured patients for copayment costs associated with high-priced drugs.

From the manufacturer’s perspective, coupons enable them to gain additional consumers, create brand loyalty, promote products and develop a competitive edge. At the same time, manufacturers can assert that consumers are saving money, receiving access to an innovative drug and improving adherence. Coupons are distributed through physician offices and are promoted on TV, in print ads, at pharmacies and through direct mail campaigns.

But how can members be sure they are taking full advantage of these programs? HealthSmartRx Solutions helps ensure maximum savings with the Variable Copay Assistance program. This unique program allows members to maximize manufacturer copay assistance programs which allows for both member and plan savings.

Here’s a high-level view of how it works:
  • Medications are filled through Accredo, our specialty pharmacy partner.
  • The copay for these medications is then increased to maximize the manufacturer’s copay assistance
  • An Accredo Specialist contacts the member upon receipt of a qualifying prescription to enroll them in the assistance program. Rarely, a member may not qualify. In that case, the copay will revert to the previous plan design.
  • By using this process, members will have little to no copay each fill, which is a huge win for the member.
  • Plan cost will be reduced by the amount of manufacturer assistance, which is a huge win for the plan sponsor.
For plans with high deductibles or out of pocket maximums, we encourage them to participate in Out of Pocket Protection for the Variable Copay Program. With this feature, only the amount the member actually pays out of pocket for the specialty drug will be added to the out of pocket maximum or deductible.

So does this program work? The answer, of course, is yes. Typical savings associated with this program is $2.00-$4.50 per member per month. We’re excited about this program as another way HealthSmart is helping improve the health of our members while reducing costs.