“We don’t cover specialty drugs”
Plans requiring members to seek manufacturer patient assistance for expensive specialty drugs as a prerequisite for coverage through a side agreement have caught the attention of pharmaceutical manufacturers.
A TPA operating in Texas promulgating this half pregnant risk management strategy is in the cross hairs of pharmaceutical manufacturers.
Their sales literature clearly states “Specialty Drugs – Full Coverage, participation in the Patient Assistance Program (PAP) is required.” This is all manufacturer patient assistance reps need to know in order to stamp “DECLINE” on applications for assistance.
Plan members seeking pharmaceutical manufacturer assistance are automatically declined based upon the assumption a side agreement is in place whether its true or not. No evidence to the contrary is asked nor accepted.
The best strategy to exclude specialty drugs is to exclude them. There’s not such thing as a half pregnant approach to anything.