RxBenefits & RxPharmacy Assurance Announce Advancements in Specialty Cost & Risk Avoidance Solutions

The sister companies expand comprehensive suite of pharmacy-specific clinical management and stop-loss solutions to help self-funded plans maintain affordable, robust pharmacy benefits.

RxBenefits, the employee benefits industry’s first technology-enabled pharmacy benefits optimizer (PBO), and its sister company, RxPharmacy Assurance, today announced new enhancements to their product portfolio designed to improve health outcomes and reduce specialty drug costs for patients and plans.

RxBenefits has expanded and strengthened its Protect suite of clinical utilization management solutions to ensure the appropriate use of high-cost medications. RxPharmacy Assurance offers new, lower deductible options and an expanded list of covered conditions for its supplemental stop-loss coverage to indemnify plans and their traditional stop-loss carriers against catastrophic specialty drug claims.

Pharmacy is the most widely used healthcare benefit, with specialty medications rapidly accelerating risk and spend. Data from RxBenefits’ book of business shows just three drug classes — specialty anti-inflammatory and dermatology drugs and diabetes medications — accounted for 45% of drug spend in 2022, without necessarily improving the quality of care.

“The pharmacy benefits landscape is more complex than ever before,” said Wendy Barnes, CEO, RxBenefits. “With drug manufacturers investing heavily in direct-to-consumer advertising and provider detailing to increase their market share and profits, employee benefits brokers, self-funded employers, and healthcare consumers need solutions that ensure they pay only for medications that offer good economic and clinical value.” Barnes continued, “Maintaining a competitive and affordable benefits package is a top priority for chief human resource officers and benefits managers, but without appropriate clinical management and catastrophic claim protection in place, most small-to-medium-sized employers will be unable to achieve that goal much longer. As we face an impending economic downturn, innovative, disruptive, and client-aligned pharmacy solutions are needed to change the trajectory.”

In 2022, the Protect suite of clinical solutions eliminated wasteful spending via independent clinical expertise, oversight, and intervention to deliver average annual plan savings in the five to seven percent range. Now enhanced to directly address the three drug classes driving disproportionate increases in pharmacy spending, RxBenefits expects its newly enhanced Protect suite of clinical solutions to deliver seven to ten percent annual plan savings, while enhancing the health and safety of patients.

The new enhancements include the expansion of the company’s proven and highly differentiated pharmacist-led prior authorization process, which encompasses a review of patient chart notes to uniquely address the recent increase in the prescribing of high-cost next-generation diabetes drugs like Ozempic® and Mounjaro™ for weight loss – something that may not be detected by PBMs’ electronic PA processes. Protect enhancements also include a high-touch therapeutic interchange solution that identifies and promotes lower-cost, effective alternatives in the anti-inflammatory and dermatology drug classes, an enhanced digital engagement platform that offers members real-time access to current prior authorization status and personalized communications, and guaranteed program savings.

RxPharmacy Assurance provides flexible, accessible pharmacy-only supplemental specialty stop-loss coverage with multi-year, laser-free protection from catastrophic specialty claims, above and beyond traditional stop-loss coverage. The new enhancements include a choice of attachment points/deductibles from $100K to $250K, a more extensive list of covered conditions that require specialty therapies, and more.

“The Protect and RxPharmacy Assurance solutions are important components of our comprehensive, layered approach to reducing pharmacy cost and risk and improving member outcomes,” said Mark Campbell, SVP of Clinical Solutions, RxBenefits.

“Our holistic approach addresses the costs and risks of high-cost medications that are impacting employers’ pharmacy benefit budgets nationwide. These strengthened solutions help our clients fight back against the rising tide of costly specialty drugs.”

Earlier this year, RxBenefits announced the launch of two new patient assistance solutions, which address key shortcomings of current patient assistance offerings while also alleviating the financial strain for plan sponsors and patients alike. Combining these solutions with Protect and supplemental stop-loss coverage from RxPharmacy Assurance creates a layered approach to help drive plan savings and mitigate risk, with particular focus on high-cost specialty drugs.

A panel of RxBenefits’ executive leaders will discuss the solution enhancements during the company’s upcoming webinar titled ‘RxBenefits Innovation 2023: Solutions for Staying Self-Funded in an Increasingly Costly Pharmacy World.’

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About RxPharmacy Assurance

RxPharmacy Assurance, Inc., a sister company of RxBenefits, is a Vermont-domiciled Sponsored Captive managed by Marsh Captive Management. Upon meeting membership eligibility requirements, self-funded plans of all sizes can access affordable supplemental stop-loss insurance designed specifically to manage pharmacy risk by forming a cell within RxPharmacy Assurance. The unique solution limits the amount that a plan or its stop-loss carrier are required to pay to safeguard against unexpected and potentially catastrophic specialty claims. RxPharmacy Assurance is offered through an exclusive network of certified insurance brokers. To learn more, visit rxpharmacyassurance.com.

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