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PBM Benefit Insights

Lower Stop-Loss exposure with Rx cost-containment strategies.

One medical claim can increase your self-funded plan renewal and how to offset using Rx cost containment strategies.

When a self-funded health plan incurs large ongoing medical claims, they rely on stop-loss coverage to mitigate this risk. However, many stop-loss plans can set individual-specific deductibles for higher-risk members. This practice, called lasering, can negatively impact a growing business's cash flow and cause increases in plan renewal costs.

Specialty drug spending currently accounts for over 50% of net spending in pharma. These brands are priced excessively high at $200+ per month.

When trying to mitigate potential stop-loss risk exposure to these catastrophic medical events and the potential negative impact of lasered claims, managing the plan impact of one high-cost specialty drug is critical.

Cost-containment is achieved by integration and cooperation with the plan and pharmacy benefit manager to maximize prescription fulfillment through non-traditional channels.

APC connects self-funded medical plans looking to utilize the savings potential of prescription assistance programs through Rx Advocacy programs. The plan can provide brand-name drugs delivered to the member at little to no cost while strategically lowering the financial impact on the plan and the individual's stop-loss limitations.

APC works with and through Benefit Advisors and offers an up-front and complimentary Rx Diagnostic and consultation to ensure we provide the right strategies for your organization's specific needs. Please get in touch with an APC Pharmacy Benefit Consultant today if you would like more information.


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