High-cost and specialty medications can significantly drive up a health plan’s costs. By enrolling members in Manufacturer’s Assistance Programs (MAPs) and sourcing drugs internationally, a plan can dramatically reduce these costs, sometimes by up to 80%.
Through MAPs, drug manufacturers sometimes offer medications at huge discounts for members who meet certain financial criteria. International sourcing is exactly what it sounds like: because many drugs are less expensive in other countries, health plans can sometimes buy the drugs internationally and bring them into the United States, effectively getting them at a discount.
Disruption: low
Frequency: low-medium (depending on the number of members receiving relevant drugs)
Impact to quality: none
Impact to cost: high
The MAP and international sourcing operating playbook
- Incorporate pharmacy solutions that specialize in savings opportunities like these into the plan.
- Use last year’s plan data to identify any high-cost drug claimants in advance, and start proactively letting members know that high-cost drug solutions are available.
- Monitor precertifications and claims for specialty and high-cost drugs. Be prepared to respond when opportunities for savings are identified.
- Engage with members, especially around MAPs. Make sure they understand the benefits, and walk them through the application process.
What can go wrong
- Missed opportunities: An employer won’t always know which employees are taking high-cost or specialty drugs, so it’s important to have precertification and claims monitoring in place to identify and reach out to these members.
The role your TPA should play
- Vendor coordination: Identify and incorporate vendors who can provide a wide range of drug sourcing options to maximize impact.
- Actively monitor claims and precertifications: Identify opportunities for savings, and respond in a timely fashion.
- Member engagement: Reach out to relevant members, explain the savings opportunity, and walk them through any actions they need to take.
