Support for your plan’s cost-saving benefit change

Through partnerships with the prescription benefit manager and plan sponsor, SaveOnSP administers the plan’s copay assistance benefit and assists plan participants with their enrollment in available manufacturer copay assistance, which could otherwise be confusing and difficult for them to navigate. With consent from the plan participant, SaveOnSP then monitors their pharmacy account on behalf of the plan to ensure assistance is applied correctly. Enrollment in copay assistance helps both plan sponsors and their participants reduce costs while keeping the plan participant on therapy. With a growing specialty pipeline and continually increasing specialty medication costs, it is critical that plan sponsors, brokers, and consultants evaluate specialty management methods that won’t sacrifice clinical outcomes or regulatory compliance for cost containment.

The plan sponsor will experience savings by leveraging the Affordable Care Act state benchmark requirements to classify certain specialty medications under the category of non-essential health benefits. These medications will not accumulate toward the plan participant’s deductible or out-of-pocket maximums. This allows higher cost-sharing to apply to the medications and a lower overall cost paid by the plan.

SaveOnSP partners with the plan’s in-network specialty pharmacy to administer the plan’s copay assistance benefit, facilitating the plan participant’s enrollment in the applicable manufacturer’s copay assistance program. Prior to filling an eligible specialty medication prescription, qualified plan participants will be directed to SaveOnSP. SaveOnSP representatives will educate them on their plan benefit design and the new copay assistance benefit, help with enrollment in the available copay assistance to lower the cost of their specialty medication, and obtain consent to monitor the plan participant’s pharmacy account on behalf of the plan on an ongoing basis. SaveOnSP provides the filling pharmacy with the necessary information to ensure the plan participant’s final responsibility for their specialty medication is reduced in accordance with the applicable plan benefit.

Only certain specialty medications are included in a plan’s copay assistance benefit. The list is proprietary and varies based on the plan’s formulary and benchmark state.

Eligible plan participants who do not agree to participate in the plan’s copay assistance benefit, specifically, they do not agree to enroll in the available manufacturer assistance program and do not consent to SaveOnSP monitoring their pharmacy account on behalf of their plan, will miss out on an opportunity to lower the cost of their specialty medication. Additionally, they may experience a higher cost-share than they previously had based on the plan’s benefit design, which now includes the copay assistance benefit. It is strongly recommended that all eligible plan participants utilize the plan’s copay assistance benefit. SaveOnSP will then be able to help ensure the plan participant’s out-of-pocket cost continues to be reduced for eligible specialty medications.