With specialty drug expenses exceeding more than 60% of the total pharmacy spend for some group health plans, it’s no surprise that employers are having to shift more costs to their members.
But as the cost for the member goes up, the chances they will actually take the drug after it has been prescribed goes down.
In fact, 61% of those prescribed a specialty medication abandon it once their portion of the monthly payment exceeds $250 or more, according to David Galardi, Pharm.D., Chief Commercial Officer of Paydhealth.
To reverse this statistic, Paydhealth provides advocacy services that help Custom Design Benefits plan members:
- Meet prior authorization criteria for high-cost specialty drugs
- Secure external funding for high-cost specialty drugs
- Receive ongoing support for each specialty drug under the program and across health care provider types
Utilizing external funding sources and alternative funding strategies, Paydhealth has been able to reduce plan participant costs down to an average of $0.51 per claim.
Paydhealth has also helped employers:
- Preserve their self-funding plan design
- Maintain stop-loss policy coverage
- Access eligible rebates and the actuarial value of the plan benefit
Due to time constraints, some of our speakers could not address every question at the conference. Fortunately, we were able to go back and provide the answers for you here.
Q: Is there any movement to disallow specialty drug advertising to the general public through the media?
A: We have not seen anything.
– David Galardi Pharm.D., Chief Commercial Officer of Paydhealth
Want more information on alternative funding for specialty drugs? Contact your Account Manager to learn more.