Balancing Pharmacy Benefits for Employees: Patient Assistance Solutions and Manufacturer Coupons Explained

In today’s competitive pharmacy landscape, providing employees with comprehensive and affordable pharmacy benefits is crucial for attracting and retaining top talent. As an employer, you understand the importance of balancing cost-effectiveness with the well-being of your workforce. That’s why it’s essential to explore innovative solutions that can help you navigate the complex world of pharmacy benefits.

In this blog, we’ll delve into two powerful programs known as patient assistance solutions and manufacturer copay assistance programs (MCAP, also known as manufacturer coupons). By understanding the nuances and benefits of these programs, you’ll be empowered to make informed decisions that will make for both healthy employees and a balanced budget.

Manufacturer coupons lower out-of-pocket costs.

Manufacturer copay assistance programs utilize coupons provided by pharmaceutical drug makers to lower out-of-pocket costs for brand medications. These coupons are distributed to promote new drugs, encourage prescribers and patients to use specific products, and reduce financial burdens.

Any employee prescribed the applicable specialty and non-specialty medications can use these coupons, which are easily accessible at the doctor’s office or online. The coupon is applied at the point of sale, covering the copay for the member up to a predetermined amount set by the manufacturer. Employers can leverage these coupons to reduce plan costs, typically through a 25% fee applied to the savings. These coupons don’t impact contract value or employee medication access, and they’re processed as part of the pharmacy benefit.

Get up to date on the state legislation trends that may impact these programs.  

Patient assistance solutions address specific income needs.

Patient assistance solutions aim to mitigate the impact of specialty drug costs, but unlike manufacturer copay assistance programs, they’re not available to all members. To qualify for these programs a member needs to provide information on their income and pharmacy benefit to access funds from the manufacturer or charitable organizations to cover the cost of certain medications.

To determine eligibility, patients must complete an application process, which requires more detailed information, including financial documentation such as pay stubs or tax returns. The application process can take several weeks to process, potentially requiring alternative methods for obtaining the prescription during the waiting period.

Learn more about the factors like company benefits philosophy, patient mix, and drug mix that should be considered when adopting Patient Assistance solutions. 

The savings potential of patient assistance programs depends on several factors, including the combination of drugs and the effectiveness of converting to patient assistance. Utilizing both programs simultaneously can be a beneficial strategy, enabling members ineligible for patient assistance to still benefit from manufacturer assistance and reduce costs. To choose the program that offers the greatest advantage, it’s important to have a comprehensive understanding of achievable savings, contractual implications, and the impact on member experience.

Both MCAPs and patient assistance solutions require independent clinical oversight.

Clinical oversight is essential for plan sponsors to ensure that the plan only covers necessary medications. Without proper oversight, members may end up on medications that are not the best choice for their condition. Employers should engage independent clinical oversight to ensure optimal medication therapies are filled.

Understanding the differences between manufacturer coupons and patient assistance solutions is crucial for employers aiming to provide cost-effective pharmacy benefits to their employees. By leveraging manufacturer copay assistance programs or exploring patient assistance solutions, employers can reduce pharmacy costs while ensuring appropriate medication management.

Independent clinical oversight plays a vital role in maximizing the benefits of these programs. By carefully considering qualifications, impact, and member experience, employers can make informed decisions to improve employee benefits and control pharmacy expenses.

 Talk to your consultant about the RxBenefits Advantage. Learn more. 

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