The Situation
This self-funded software company with more than 1,200 employees faced a major scare in 2023 when one of their employees was diagnosed with hypophosphatasia, an inherited genetic disorder affecting the development of bones and teeth. The company was looking at an $800K claim, which would be devastating to their budget.
The Solution
Thankfully, in 2022, the company had the foresight to mitigate the risk of large and unexpected pharmacy claims by obtaining coverage through RxPharmacy Assurance. This flexible, accessible stop-loss solution is designed to protect employers against the risk of high-cost specialty medications used to treat a wide variety of conditions.
With this coverage already in place, the company was well protected and able to successfully avert this budget-breaking specialty claim. Once that new hire’s claim hit the $250K deductible, the plan was eligible for reimbursement for qualified expenses.
RxPharmacy Assurance includes an annual benefit exceeding $1M beyond the deductible for each year, condition, and claimant. With a lifetime cap set at $3M, RxPharmacy Assurance ensures continuous annual payouts as long as the policy remains active, persisting until the cap is reached.
Contact us today to get a full understanding of our supplemental stop-loss solution, how it works, and the benefits it can provide to self-funded employers.
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