The rising cost of drugs challenges the mission of commercial and government payors to provide broad access to healthcare and drugs at affordable costs. To achieve their mission, health plans and government programs have implemented numerous utilization and cost management programs, some directed specifically at controlling the cost of orphan and ultra-orphan drugs for rare chronic conditions.
BioSolutia’s applies its applies its wealth of experience and understanding of managed care principles to the design of programs that align to the spectrum of payor considerations, including:
Payors must understand the rationale, and adjust underwriting and budgets, for any incremental drug costs and understand the return on investment of a specialty drug in controlling total healthcare costs.
Coverage policies must be drafted and approved by the payor, often including administrative rules for approval of coverage.
Payors must determine the formulary status of drugs, particularly for drug classes with multiple therapeutic options.
Payors may seek to influence options regarding physician buy and bill, or Assignment of Benefits (AOB) covered prescriptions based on the appropriate site of care.
Programs must account for billing codes and other information required by the payor for approval and payment.