Healthcare arbitrage #3: MAPs and international sourcing

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.

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Disruption: low

Frequency: low-medium (depending on the number of members receiving relevant drugs)

Impact to quality: none

Impact to cost: high

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The MAP and international sourcing operating playbook

1. Incorporate pharmacy solutions that specialize in savings opportunities like these into the plan.
2. 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.
3. Monitor precertifications and claims for specialty and high-cost drugs. Be prepared to respond when opportunities for savings are identified.
4. Engage with members, especially around MAPs. Make sure they understand the benefits, and walk them through the application process.

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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.

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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.

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