3 ways your employees can access medications for free - Part 1

At the highest level patient assistance programs are dollar set aside by drug manufacturers to help patients that are underinsured or uninsured um get medicine in their hands so if you you know the the marketing of all these major you know drug manufacturers for the latest greatest medicine that they're all over TV right and there's always something at the end that says hey call you know XYZ manufacturer they may be able to help you afford this medicine they are setting aside billions of dollars a year to help patients that are underinsured or uninsured and so what we are able to do with the right plan and the right you know education process is find those two percent of people take that are driving about 50 to 60 percent of prescription spend with what's called specialty drugs and we basically help them access those funds in those funds then cover the cost of the medicine and the patient gets it for free so it's kind of that win-win now none of these strategies come without some pros and cons and things we need to consider keeping it high level that that's how the program essentially works is we tap in to those billions of dollars that have been set aside yeah and for for the employers on the phone there's income qualifiers that that come along with this right so not everybody not everybody will uh necessarily uh get these uh if you have a super high paid population this strategy probably not a strategy that you want to implement but if you have a lower paid population maybe you're in the manufacturing space that's where we see this uh is extremely successful an example is a 25 000 drug called Stelara that we have on many of our plans headed on one of our plans patient applied for patient assistance was approved procured that twenty five thousand dollar drug for free we had a very small administrative fee five hundred dollars to procure that drug so the the patient saved a huge co-pay because they were on a high deductible Health Plan and the employer saved to the remainder which is twenty four thousand five hundred dollars every time script is filled so yep I want to clarify now because again if I was on the phone and I was an employer I'd be wondering why can't I do this in my fully insured plan why can't I do this in my self-funded plan with Blue Cross or United or retina or Cigna right can I tap into these right now and then and the quick answer is no um Trevor why is that yeah I think the short answer goes back to incentive alignment right so as drug costs go up in more high cost drugs come in that's where um insurance carriers and large prescription benefit managers continue to make more money so it doesn't behoove them to actually eliminate that from the plan it behooves them to pay for it and get a really large rebate on the back end to help with profitability and things like that so that's really why the deck is stacked against you in in a lot of health care plans because they're they're incentivized not to keep costs down and find Creative Solutions and incentivize to just keep paying paying paying with your money and so the patient assistance program I will say patient assistance is probably the most volatile um piece of the prescription ecosystem in America right now there's a lot of things going on with manufacturers some people don't think that self-insured plans should be able to tap into it there's different income requirements as you know so there's a lot to talk about with that piece but as Mike said for the right employer um it can work very effectively with the right partners