Many members are experiencing increased cost to their employee benefit programs during a time when they are looking for savings and sustainability. High-cost specialty drugs can represent more than 20% of total drug plan cost and come from less than 1% of employees. The ongoing expense of these drugs can cost a benefits program well over $60,000 annually. As the number of indications that high-cost specialty drugs provide therapy for increases, so does their exposure to the financial sustainability of benefit plans.
As a result, RMA Benefits is introducing Formulary Protect Plus: the alternative funding arrangement for high-cost drugs. The program provides coverage for most prescribed medications and limits the exposure of high-cost prescriptions by navigating the expense of high-cost specialty drugs that are known to be covered through manufacturer and government programs. This unique formulary can help mitigate exposure and may potentially provide long term coverage for plan members and their families even after they move on from your organization.
Once a plan member has applied for special authorization coverage of a high-cost drug, they will receive RMA Benefits' Coverage Navigation Service. Clinical services experts provide specialized assistance and guidance on coverage options to the plan member for the specialty drug. The RMA Benefits team will continue to work with the plan member, as future courses of treatment may be altered by the plan member's physician over time.
Formulary Protect Plus ensures employers will become the payer of last resort with a plan member when applying for special authorization coverage.
For more information, please contact:
Manager of Benefits