CALENDAR OF EVENTS

THE PSYN ADVANTAGE

LEVERAGING OVER 30 YEARS OF HEALTH INSURANCE EXPERTISE

With over 30 years of contract negotiation, medication compliance
and clinical experience, we have the knowledge and expertise
necessary to accelerate your team’s healthcare goals.

Pharmacy Matters

CMS BEST PRICE AND COPAY
ASSISTANCE PROGRAMS

COPAY ASSISTANCE PROGRAMS

A new CMS policy, issued in December 2020 with effective date of January 1, 2023 has produced much concern from PHRMA regarding the future of patient assistance
coupon programs. These are programs like discount cards that the drug manufacturers give to patients who are prescribed extremely high cost specialty drugs that cover the majority of their out of pocket costs. However, the new policy requires that manufacturers must ensure that all of the assistance goes to the patient to avoid any Medicaid “Best Price” implications. Ensuring this is nearly impossible and will most likely cause a change in PHRMAs strategy. Read more.

CONTRACT TERM TIP OF THE MONTH

DOES YOUR PRESCRIPTION DRUG BENEFIT ACCOUNT FOR COPAY ASSISTANCE CARDS?

PHRMA provides copay assistance cards to members to lower their out of pocket costs
for high priced brand name drugs. Some of the cards cover upwards of 90% of the
members’ cost. Without benefit controls in place, the copay card can cover a member’s
entire deductible in one or two transactions leaving the employer sponsored health
insurance to pick up the cost of all other medical expenses for the entire plan period.
Protect yourself by implementing a Copay Accumulator Adjustment Program (CAAP)
To learn more, contact us at [email protected].