Meritain Health® provides the consultative services and support our clients need to address and lower employee health plan spending. Recently, negotiation services from the Meritain Health Cost Management team helped alleviate an extreme financial burden faced by one of our clients.
Distressing financial situation
Client A has an employee battling a health condition, who was prescribed a specialty medication for treatment. Like many specialty medications, this particular drug was uncommon and came with a high price tag.
Client A was facing a difficult situation. Over an eight-month treatment period, the baseline cost of the employee’s medication was $1.4 million to the health plan. Even with a network discount, the cost was still $1 million. The impact of these medical costs could have devastating consequences on the company’s budget, but the medication was necessary to protect the employee’s life.
Meritain Health Cost Management stepped in to help.
Cost Management Negotiation on Specialty Medication
Initial cost: $1,421,500
Network cost: $1,006,550
Final cost after negotiation: $245,260
Tireless efforts to negotiate savings
A team member from Cost Management was determined to help Client A save on the cost of the specialty medication. The team member worked hard to ensure cost intervention. His main focus was negotiating the price of the drug directly with the manufacturer. His negotiation was based on a complex case review that included clinical review of drug usage, financial review of drug cost and ruling out possible treatment alternatives.
In the end, the team member’s efforts resulted in an additional discount of over $760,000, which was more than an additional 50 percent discount beyond the quoted network price of the drug.
In addition, his work helped ensure stricter financial and clinical reviews of this particular drug going forward. This will help Client A and the employee continue to save in the future, and provide the best possible health outcomes for the employee.
To learn more about Meritain Health benefit plans, which include our Cost Management services, please contact your Meritain Health representative.
This story is based on an actual client experience. Names and information have been changed to protect the client’s privacy.
This communication is intended for informational, promotional purposes only. The amount of total savings represents the savings off out-of-network billed charges that are the product of individual negotiations directly with the provider. The reference to previous outcomes made as a part of this communication does not guarantee success or similar outcomes in any new or future negotiation, as the result of each case depends upon many factors, including but not limited to the facts of each case.
Health benefits and health insurance plans contain exclusions and limitations; see your plan documents for complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary and are subject to change.