General Patient Assistance Questions

What are Patient Assistance solutions and how do they work?

Patient Assistance solutions supply medication to uninsured or underinsured patients through alternative funding sources, such as drug manufacturers. Typically, patients undergo a qualification process, and program approvals are subject to the patient meeting certain eligibility requirements, largely based on household income. In recent years, employers have been leveraging Patient Assistance solutions to shift costs by not covering specialty medications as part of their pharmacy benefits plan and instead engaging a third-party organization to assist their members in obtaining funding for their specialty medications.

In the past, RxBenefits has not offered a Patient Assistance solution. Why have you decided to offer a solution now?

Historically, Patient Assistance solutions have been positioned largely as financial programs designed to shift costs away from the employer and member. Many of these solutions sacrifice sound clinical oversight and a quality member experience. To aid our clients, prospective clients, and brokers, we wanted first and foremost to ensure our solutions resolved the gaps we see in most current options by providing clinical oversight and
coordination, and by delivering a member experience that exceeds expectations.

Do you believe Patient Assistance solutions are effective in managing specialty spend?

We do not believe any single solution can effectively manage specialty drug spend. However, for some employers, Patient Assistance solutions can be one part of a broader, comprehensive specialty management approach. Ultimately, we believe a layered approach that includes multiple solutions is the best way to build an effective specialty management plan that focuses on both cost and risk.

Are Patient Assistance solutions a good option for all employers?

We believe they can be a good option for some employers. The opportunity to save is largely dependent upon the employer’s patient mix, drug mix, and the specialty rebate arrangement. Program fees also should be factored into the decision. With the proper claims information, RxBenefits can run a complimentary analysis for any employer interested in our Patient Assistance solutions.

RxBenefits Related Questions

Are your preferred Patient Assistance solutions available to all clients?

Initially, our solutions are available only for clients who have RxBenefits’ Optimize 360 product.

Why did you select Amwins Rx and SaveOnSP Advantage as your solutions providers?

We selected Amwins Rx and SaveOnSP Advantage for several important reasons.

• Quality, reliability, and scalability
• Coordination with the solutions providers
• Ability to conduct retrospective reporting to verify program performance

Can you provide any information about the Amwins Rx solution?

Here’s how it works:

• Upon receipt of a new prescription, an RxBenefits clinical pharmacist conducts an unbiased review to ensure clinical appropriateness.
• Assuming the prior authorization is approved, the member fills the prescription under the pharmacy benefit.
• If Amwins Rx identifies the member has filled a targeted medication, an Amwins Rx representative reaches out to assist the member in applying for need-based financial assistance.
• If the member qualifies and funds are available, future prescription refills are dispensed at no cost to the member or plan.
• If funding is not secured because the member does not qualify, the medication continues to process through the pharmacy benefit.

Can you elaborate on the SaveOnSP Advantage solution?

Here’s how it works:

• Upon receipt of a new prescription, an RxBenefits clinical pharmacist conducts an unbiased review to ensure clinical appropriateness.
• Assuming the prior authorization is approved, a SaveOnSP Advantage representative assists the member in applying for need-based financial assistance.
• If the member qualifies and funds are available, the prescription is filled at no cost to the member or plan.
• To ensure the member is never without needed medication, they can begin their therapy via a short fill (courtesy fill for less than a 30-day supply) while awaiting program approvals.

If a participating member does not qualify for assistance or funds for a prescribed medication have been exhausted:

• SaveOnSP copay assistance dollars cover the member’s cost share.
• The plan is responsible for the balance of the cost of the prescription.
• The plan sponsor foregoes its opportunity to earn rebates on the claim.

Note that if a qualifying member does not agree to participate in the program, they are automatically liable for the full cost of the medication at the point of sale.

What do your preferred partners charge for their programs?

There are no implementation fees. There is a 25% shared savings fee with each partner.

Is RxBenefits earning any commissions on the implementation of a Patient Assistance solution?

In keeping with our client-aligned model, RxBenefits does not accept any commissions on our preferred Patient Assistance solutions. We offer them as a service to our clients and brokers.

Do employers need to implement these programs at the beginning of their annual benefits year?

Our solutions can be implemented any time throughout the year. Please note that Amwins Rx requires a 30-90 day implementation, while the SaveOnSP Advantage implementation takes about 75 days following the established SaveOnSP calendar.

Does implementing one of the Patient Assistance solutions require changes to the Summary Plan Description (SPD) language?
Yes, this is a requirement. Our partners have recommended SPD language we can share, but ultimately all SPD language is owned by each client and its legal team.

How do I request an analysis?

Contact your RxBenefits Business Development or Account Team representative. A claims file will be required to conduct the analysis.

 

 

 

Amwins Rx and SaveOnSP are independent, third-party companies and are not agents for, not joint venturers of, not employed by, and not affiliated with RxBenefits. The preferred Patient Assistance solutions described herein are subject to the terms and conditions of the applicable third-party service provider. The decision to select or hire any third-party service provider is at the sole discretion of the client.