Specialty Drug Assistance Programs

By Kari Hoback, Senior Account Manager

April 21, 2022

Many employers are concerned with the increasing cost of prescription drugs, and in particular the high cost of specialty drugs.  In recent years, most plans have added a separate employee cost sharing tier for specialty drugs; but even with increased member responsibility, the majority of the additional spend falls on the health plan.

At Watko Benefit Group, we are continually exploring ways to help our clients control specialty drug costs.  We partner with Pharmacy Benefit Managers and other vendors that have expertise in this area to review drug spend and implement programs to help curb costs.

Copay Maximization

Many drug manufacturers offer copay assistance.  Once these are identified and utilized, the member cost share can be increased and then paid by the copay assistance so that both the member and the plan receive savings.

Alternative Funding

Various benefactors (healthcare organizations, grant programs, and endowments) offer funding in order to maintain access to specialty drugs.  Alternative funding vendors help connect members to these programs and walk them through the process to apply for funding.  If approved, savings is realized by the member and the plan.  The fee charged by the vendor is a percentage of the savings to the plan.

Watko Benefit Group recently implemented alternative funding for a self funded client, and within 60 days four members were approved and receiving their specialty medication at no cost.

Contract and Performance Review

Independent consultants analyze prescription drug claims data, negotiate PBM contracts that are cost effective and transparent, and verify PBMs are performing as promised.

While the prescription drug market is complex, there are resources and experts available to help explain how it works and find ways to mitigate confusion as well as costs.

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