OCTOBER 05, 2021 — RxPharmacy Assurance, a sister company of RxBenefits, Inc., announced today that its stop-loss supplement to manage high-cost specialty drug risk is now fully available to brokers and their self-funded employer clients across the nation. A Vermont-domiciled Sponsored Captive managed by Marsh Captive Management, RxPharmacy Assurance uniquely enables self-funded employers of all sizes to access a supplemental stop-loss product at affordable rates that provides safeguards from unexpected and potentially catastrophic specialty drug claims. The RxPharmacy Assurance solution can protect plans against future lasers and help brokers and plan sponsors negotiate improved stop-loss premiums.
Self-funded employers face skyrocketing prescription benefit costs driven almost exclusively by specialty drug claims. In fact, specialty medication costs accounted for over 50% of the total pharmacy spend incurred last year, and two-thirds of human resource leaders now say that high-cost specialty drugs have become their #1 pharmacy benefits concern. Because the drug therapies behind these costly claims often target chronic conditions – with around 70% of costs driven by just six conditions – employers will also continue to pay for them long-term.
While traditional stop-loss insurance is important, it is not a complete solution to address the rising costs and utilization of specialty drugs. Stop-loss coverage plans are renewed annually, which can result in a large claim being covered for just a few months before the patient is lasered, leaving the employer exposed the following plan year. In addition, carriers typically issue significant rate increases following claims, making coverage unaffordable for employers.
“Self-funded employers are increasingly feeling the impact of the rising costs of specialty drugs and are in need of a complete solution,” said Paul Fortunato, Senior Director, Clinical Initiatives, RxBenefits. “Using stop-loss insurance on its own is like providing short-term and long-term disability coverage to employees, but only buying short-term disability insurance,” Fortunato continued. “RxPharmacy Assurance is designed to fill the gap where traditional stop-loss insurance falls short. The RxPharmacy Assurance solution enables brokers to help self-insured employers of all sizes manage their risk and protect themselves from high-cost specialty claims.”
The RxPharmacy Assurance solution affords self-insured employers that meet membership eligibility requirements the ability to access supplemental stop-loss insurance by forming a cell within RxPharmacy Assurance. The unique solution offers members access to:
- Supplemental stop-loss coverage that complements existing stop-loss and limits the amount that the plan or its stop loss carrier are required to pay for covered specialty drugs
- Protection against lasering, maintaining member coverage under the group’s existing stop-loss policy
- A method to potentially negotiate more affordable rates and guard against sharp premium increases
Brokers who are interested in learning more can find additional details at http://rxpharmacyassurance.com/.