PayerAssist Program

BioPlus has two decades of specialized care which makes us a valuable and necessary resource for Health Plans interested in resolving the issues associated with specialty medications.

Much in the same way our other Assistance programs are designed to help our clients navigate their various situations, the PayerAssist program provides the innovative, forward-thinking service for which payers have been searching.

Whether you currently have a specialty drug program or are considering the benefits of one, you have probably asked:

• What makes a medication a 'specialty' medication?
• What are the goals of initiating a specialty drug program?
• Which is more important price or profit?
• Which organization can provide the level of care and clinical expertise to meet our goals?
• Which organization can show a true value and document outcomes, provide clinical interventions as well as ensuring higher satisfaction among your groups?
• Is there an independent specialty pharmacy that can remain focused on the sole goal of better patient care and easier direct access for our organization as well as for our members?
• Is a mandatory plan best overall? What about allowing multiple providers?
• How will we implement this program?
• How will we measure outcomes to determine the benefits of the program?
• Is there a specialty pharmacy that can show the value of successful outcomes as well as provide sometimes costly interventions as part of their standard protocol?
• If you currently have a program in place: Are you seeing the results you had expected? Are you having an increase in member and group satisfaction? Are you able to justify your program?

If you already have a specialty program in place or you are considering the benefits of implementing one, it is necessary to analyze the current pharmacy marketplace. BioPlus views the common pharmacy situations as:

Retail Pharmacy: A pharmacy which is also a retail store. Retail stores do not normally stock high cost specialty medications. The focus is on commonly prescribed oral medications. Clinical monitoring is not necessary. Access to a pharmacist is limited; after-hours pharmacist access is uncommon.

Specialty Mail Order: A facility whose focus is on dispensing a 90-day supply of medications. Clinical monitoring of the patient is not practiced. Many specialty mail order facilities also operate retail pharmacies. The majority of specialty mail-order facilities are owned partly or in whole by Prescription Benefit Management (PBM) companies. Access to a pharmacist is limited.

Specialty Pharmacy: A Pharmacy that is focused on the needs of complex treatments which include infusion therapy. The primary focus is that of long-term, complex treatment of chronically ill patients. Dispensing of medications is dependent on the clinical needs of the patient. Due to the complex nature of the illness, clinical monitoring and intervention is common.