Meet Assura: Our Net Cost Guarantee Pricing Solution

The cost of specialty medications continues to rise. With a growing pipeline of specialty drugs and newer therapies costing in excess of $100,000 for a single course of treatment, a handful of claims can significantly impact a plan’s financial performance and stability. At the same time, utilization of specialty drugs, particularly those treating cancer and autoimmune conditions, is also increasing. In this climate, plans need a new approach and a PBM partner that is fully aligned with their goals and invested in helping them navigate this complex and uncertain environment.

Our Solution: Net Cost

Bringing Predictability & Accountability in Drug Spend Management.
To protect health benefit payers from the risks of high-cost medications and drug mix changes, Abarca has created a better way to help manage pharmacy benefit costs. Through Assura, Abarca will guarantee the net cost of drugs, including specialty medications, by offering an annual fixed per-script cost for your entire population. The guarantee will be adjusted annually based on drug benefit coverage changes.

How It Works: A Partnership.

Abarca will utilize the plan’s claims history, eligibility, plan design, and utilization strategies to calculate a per script guarantee. Our pricing option continues to put the plan in control: the plan maintains the choice of plan design and utilization management rules.

A Straightforward & Understandable Financial Model.

Abarca then goes to work and develops a new, straightforward, and understandable net cost model that protects the plan from the most common sources of cost increases, including drug mix, inflation, and other factors. This model excludes utilization changes resulting from shifts in the disease burden of the population.

Total Predictability.

By implementing this new cost model, plans will be better positioned to budget their drug spend into the future with confidence. Abarca makes quarterly payments under the guarantee and provides full reconciliation and reporting.

A “Client First” Approach.

We are driven to lower the cost of pharmacy for our clients without increasing the burden on their members. With our guaranteed price model, Abarca makes quarterly reconciliation payments and provides full reporting.

Better Analytics & Clinical Programs.

Abarca’s technology platform, Darwin™, provides the highest levels of business intelligence and visibility into costs and trends. Our medication therapy management, chronic disease, and other clinical programs provide members the care they need to stay adherent and healthy, while also controlling plan costs.

Milliman Review: Evaluation of Net Cost Guarantee Arrangement Calculations

Milliman concluded that the reconciliation methodology for Assura is “an appropriate methodology and that the calculations reviewed from Abarca follow the prescribed methodology and are actuarially appropriate.” In addition, Milliman stated that “the arrangement provides transparency and predictability while including a straightforward methodology for reconciliation.” To read the full report, click here.

A different kind of PBM

If your PBM is going to continue to take spread, chase rebates, and drive utilization to higher drug prices, maybe it’s time to consider a different kind of PBM.

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