New Edge Solutions
Affording Rx: Assistance programs & International Sourcing
Nearly every time you turn on the news, you hear about: the cost of prescriptions in the US is continually out of hand, and seemingly increasing by the day without an eye in sight for change.
I recently read a story where an Rx company took their existing prescription drug and simply changed the coating (actually reducing efficacy) to extend their patent and thereby push out potentially cheaper generics that were soon to enter the market(1).
Which brings us to a "solution", which I put in quotes because this does not solve for problems like those mentioned above, however it can help some members and plans out. There are, for members at a certain income threshold, copay assistance and foundation assistance programs where individuals can have all or part of the cost of their drug covered by these charitable organizations or the drug manufacturer themselves.
There are issues with these programs, from a timing perspective (approval is needed, can take weeks, and requires annual reapproval) are often not easily navigated by patients, and the income thresholds while generous, will still leave well-to-do Americans in financial hardship. But they can help those who may otherwise forgo their prescriptions or be put in a place of significant financial hardship.
The other option many American's are turning to is International sourcing. A number of companies have popped up to help facilitate these transactions as PBMs cannot directly source these scripts for members, but can give guidance to members for how to obtain these.
Humira, for example, is $55,000 annually in the US, but only $22,000 in Mexico(2)
We are excited that we will be launching a solution, Benefits Optimization Plan (BOP), to help members advocate and navigate the assistance program, as well as navigate International sourcing should that be the optimal route for cost savings.
(1)Rosenthal, E. (2018). An American sickness: How health care became big business and how you can take it back. Missouri Medicine, 115(2), 128.
(2) Barret, R. (2018). International drugs cut prescription expenses for self-insured employers. Employee Benefits News. Retrieved from: https://www.benefitnews.com/news/international-drugs-cut-prescription-expenses-for-self-insured-employers