SaveOnSP is a company comprised of healthcare and pharmaceutical industry experts with a mission to help plan sponsors and their participants reduce the high cost of certain specialty medications. SaveOnSP offers consultative and administrative services to employee benefit plan sponsors and commercial health insurers to support and implement a change to their existing plan benefit design. The plan’s new copay assistance benefit is consistent with Affordable Care Act (ACA) regulatory requirements and focuses on delivering optimized health outcomes.

The plan’s new copay assistance benefit creates a unique savings opportunity for plan sponsors and their participants by using available manufacturer copay assistance. The copay assistance benefit aims to ensure plan participants can overcome financial barriers while driving improved treatment adherence.

The plan sponsor will experience savings by leveraging the Affordable Care Act state benchmark requirements to classify certain specialty medications as non-essential health benefits. These medications will not accumulate toward the plan participant’s deductible or out-of-pocket maximums. This allows higher cost-sharing to apply to the medications and a lower overall cost paid by the plan. The designation of a drug as “non-essential” does not relate in any way to the importance or necessity of the drug for the plan participant or their condition.

SaveOnSP partners with the plan’s in-network specialty pharmacy to administer the plan’s copay assistance benefit, facilitating the plan participant’s enrollment in the applicable manufacturer’s copay assistance program. Before filling an eligible specialty medication prescription, qualified plan participants will be directed to SaveOnSP. SaveOnSP representatives will educate them on their plan benefit design and which manufacturer copay assistance program may be available to them to lower the cost of their specialty medication. Finally, SaveOnSP obtains the plan participant’s consent to monitor their pharmacy account on behalf of them and their plan on an ongoing basis. SaveOnSP provides the filling pharmacy with the necessary information to ensure the plan participant’s final responsibility for their specialty medication is reduced in accordance with the applicable plan benefit.

The copay assistance received by the plan participant typically will not apply to any deductibles or out-of-pocket limitations unless prohibited by state law or plan benefit specifications. Most plan sponsors create an equal pharmaceutical benefit across their population by preventing manufacturer dollars from subsidizing the shared medical and pharmacy deductible or out-of-pocket obligations.

Plan participants are required to complete the available manufacturer copay assistance program’s enrollment process and consent to SaveOnSP monitoring their pharmacy account on their behalf and on behalf of their plan. If a plan participant is not already enrolled in the available manufacturer copay assistance program, SaveOnSP will educate them about the enrollment process. Plan participants who utilize the plan’s copay assistance benefit can expect a lower cost for all eligible specialty medications included in the benefit.

Yes, however, SaveOnSP will educate the plan participant on the plan’s benefit change and the new copay assistance benefit.

No, the copay assistance benefit can be implemented as soon as the plan documentation (Summary Plan Description [SPD], Summary of Material Modifications [SMM], Summary of Benefits and Coverage [SBC]) and plan design changes are made, consistent with applicable law. Each plan sponsor should consult with its legal counsel and advisors to decide whether mid-year benefit changes can be made and determine the process needed to make such changes.

Contact your benefits consultant or pharmacy benefit management account team for further information.

Only certain specialty medications are included in a plan’s copay assistance benefit.

Eligible plan participants who do not agree to participate in the plan’s copay assistance benefit — specifically, they do not complete the available manufacturer assistance program’s enrollment process and do not consent to SaveOnSP monitoring their pharmacy account on behalf of their plan — will miss out on an opportunity to lower the cost of their specialty medication. Additionally, they may experience a higher cost-share than they previously had based on the plan’s benefit design, which now includes the copay assistance benefit. It is strongly recommended that all eligible plan participants utilize the plan’s copay assistance benefit. SaveOnSP will then be able to help ensure the plan participant’s out-of-pocket cost continues to be reduced for eligible specialty medications.

SaveOnSP has offices in Buffalo, NY, Vero Beach, FL, and Denver, CO. 

Through partnerships with the plan sponsor and its pharmacy benefit manager, SaveOnSP administers the plan’s copay assistance benefit and educates plan participants about available manufacturer copay assistance, which could otherwise be confusing and difficult to navigate. With consent from the plan participant, SaveOnSP then monitors their pharmacy account on behalf of the plan and the participant to ensure copay assistance is applied correctly.

Participation in the benefit helps plan sponsors and their participants reduce costs while keeping the plan participant on therapy. With a growing specialty pipeline and continually increasing specialty medication costs, it is critical that plan sponsors, brokers, and consultants evaluate specialty management methods that won’t sacrifice clinical outcomes or regulatory compliance for cost containment.