MAXIMIZE SPECIALTY DRUG COPAY ASSISTANCE AND TRACK TRUE MEMBER OUT-OF-POCKET COSTS
How do we do that?
CAAP Rx proactively identifies assistance programs provided by specialty drug manufacturers and applies Serve You Rx clinical intelligence to dynamically adjust benefit design for participating specialty drugs.
Under this program, the amount the plan pays for specialty drug prescriptions is lowered by adjusting the member cost share amount to take full advantage of the assistance offered by drug manufacturers. The adjusted amount is accounted for via accumulator management. CAAP Rx dynamically sets member cost share by drug for each dispense, based on dose, frequency of administration, and available manufacturer financial assistance. The result is continued affordability for the member, promotion of adherence to therapy, and maximum plan savings.
The CAAP Rx Solution
- Plan sponsors have visibility to available specialty drug assistance programs
- Dynamic copay structures are customized by drug to maximize 100% of available manufacturer financial assistance
- Assistance provided by drug manufacturers is not applied toward deductibles or maximums
- Accumulator tracking accurately reflects actual member out-of-pocket spend
- Keeps member costs low
- Avoids a major cost shift to members should drug manufacturer assistance be exhausted prior to benefit year-end or maximums being met