Specialty Med Coupon Optimization
The Challenge
The firm was paying full price for several high-cost specialty medications, unaware that manufacturer assistance programs were available to offset these costs. Their bundled PBM was not actively pursuing these credits, allowing the plan to bear the full financial weight of the claims.
The IMPACT
This lack of oversight resulted in the plan missing out on significant funds that could have lowered the overall stop-loss premium. The employer felt they were overpaying for specialty care while the PBM and manufacturers were the only ones benefiting from the arrangement.
The Strategy
We introduced a manufacturer coupon optimization program that reviewed every specialty claim to identify available assistance funds. These credits were then applied directly to the plan’s cost, ensuring the employer received the full benefit of the manufacturer’s support.
THE OUtcome
The initiative successfully recaptured significant funds that were previously being left on the table. This outcome stabilized the plan’s medical spend and reinforced the importance of active pharmacy management in a high-utilization environment.
Things Employers Should Consider
Manufacturer assistance is often available but hidden behind complex administrative layers. Employers need an advocate who can ensure these funds are used to reduce the plan’s liability rather than just padding the provider’s margins. It is a critical step in fulfilling your fiduciary duty to manage plan assets effectively.