RxBenefits Provides New Solutions to Facilitate Access to Patient Assistance Programs

RxBenefits has launched two new solutions to help its self-insured clients and patients access available drug assistance programs. Specialty medicines now account for 55% of medication spending in the United States according to IQVIA. Officials with RxBenefits said costly specialty drugs challenge plan sponsors in terms of costs and access.

Bradley Nelson, Pharm.D.

“We’ve come to a crossroads with specialty medications,” Bradley Nelson, Pharm.D., senior director of clinical Services at RxBenefits, said in an interview with Formulary Watch. “They provide life-changing therapeutics for members that have complex conditions and for rare diseases, but the set price points for these are extremely expensive. Plans are having a difficult time affording the benefit.”

When RxBenefits polled benefit advisors at its State of the Industry 2023 webinar, about half of the audience reported clients ask about alternative funding the most, and 75% to 100% of their clients are dealing with a high-cost specialty medication concern today.

Pharmaceutical manufacturers’ medication assistance programs can be viable options. Members may delay treatment for weeks while trying to access programs for their medications. The percentage of members impacted on average is only 2% but they represent 50% of pharmacy benefit spend. A delay in care can have a significant impact for the employer far beyond the financial cost.

RxBenefits’ new patient assistance solutions help members find and apply for alternative sources of funding for costly medicines. “We help facilitate the enrollment of those patients that are either uninsured or underinsured for certain medications so that they can have access to the manufacturer programs,” Nelson said.

He said that a lot of patients don’t realize that these programs are available. “And even sometimes when they do, they don’t necessarily have the advocates and navigators that help them get through the process,” he said. “Clients have been asking us for a solution like this.”

A multi-pronged approach is needed to address both specialty drug spend and volatility to do what’s right for patients by making specialty drugs more accessible and affordable for them and plan sponsors, RxBenefits officials said. Patient assistance solutions, used along with RxBenefits Protect provides options to maximize the benefits of alternative funding while still ensuring patients receive medication. RxBenefits Protect is a solution that offers independent clinical expertise, oversight, and intervention of pharmacy spending. The Protect programs are designed and led by independent Pharm.D.s to ensure the plan pays for appropriate and necessary medications.

Nelson said that clinical oversight is an important piece of the new solution. “From a clinician standpoint, we want to make sure that our members are having appropriate utilization. And once the person is on the right medication, then there are appropriate solutions to analyze the patient assistance piece of it. It’s what meets the goals and objectives of our self-insured employer group.”

Nelson said RxBenefits doesn’t charge sponsors for the new solution, but the vendor chosen to the support this program charges a percent of shared savings.