07.20.23 Featured Blog

Plan Sponsors Need Flexibility in Supplemental Stop-Loss Insurance as Specialty Drug Market Evolves

The specialty drug market is evolving. Prices are rising at alarming rates and new specialty drugs are coming to market with six-figure price tags. What’s more, specialty drug use cases are expanding not just for treatment of rare diseases, but for more common, chronic disorders as well. In addition, specialty medications are having a greater impact on overall pharmacy costs — making up approximately 55% of total drug spend for many plans.

If your self-insured employer client hasn’t felt the burden of these growing costs yet, it’s only a matter of time before they’re hit by a catastrophic claim: an employee or dependent may receive a new diagnosis, a new indication for medication can make it a fit for a member once on a cheaper drug, or a new hire may join the organization with a condition that results in a large pharmacy claim. These often unexpected claims can be budget-breaking and business-shattering.

The wait-and-see approach isn’t a viable option in today’s volatile market. Therefore, most small and midsize employers with self-funded pharmacy benefits plans pair coverage with traditional stop-loss insurance to protect against catastrophic claims. However, this type of stop-loss insurance wasn’t created to protect employers against the recurring high-cost claims associated with chronic conditions.

Self-funded employers have noted considerable gaps in traditional coverage. These limitations arise when a stop-loss carrier increases rates by as much as 50%, adds limits, or creates exclusions for members with known high-cost, chronic conditions.

Supplemental Stop-Loss Insurance: Predictable Specialty Coverage in a Volatile Market

That’s where supplemental specialty stop-loss insurance comes into play. Bundling traditional stop-loss insurance with RxPharmacy Assurance allows employers to get back to the core of why they adopted self-insured plans — to gain better control of the pharmacy benefit with greater transparency and financial benefits. And now, RxPharmacy Assurance’s supplemental stop-loss insurance solution has even greater advantages through several new enhancements:

  • Increased accessibility and flexibility: To make coverage more accessible and flexible, RxPharmacy Assurance now offers deductibles starting as low as $100K, with a maximum payout of $1M per year, per condition, per claimant, and up to $3M per condition, per claimant lifetime. With this enhancement, more employers can choose the right coverage for their plan’s needs.
  • Expanded coverage of specialty conditions: A number of new specialty drugs continue to hit the market each year. RxPharmacy Assurance now offers coverage for virtually all specialty conditions to ensure greater protection. This added protection also helps limit traditional stop-loss carrier risks and provides a mechanism for brokers and self-funded plans to negotiate reduced stop-loss rates.

Going above and beyond traditional stop-loss coverage, the RxPharmacy Assurance approach helps clients fight against the rising tide of costly specialty drugs. By expanding the flexibility of key features, RxPharmacy Assurance provides better protection to self-insured employer clients by reducing pharmacy costs and risks.

Contact the team today to learn more about RxPharmacy Assurance’s new and continuing protection options.