Elixir debuts specialty generic enhancement for plan sponsors, members

Elixir, a subsidiary of Rite Aid, launched a specialty generic medication enhancement to its managed copay solutions that allow members to receive generic versions of certain specialty medications at a $0 copay.

This enhancement has the potential to provide an average savings of up to $40,000 annually, the company said. 

“As specialty drug costs continue to climb and account for a significant amount of drug spend, Elixir is continually looking for innovative solutions for our clients,” said Marly Arbuckle, senior director, specialty solutions and strategy for Elixir. “With this specialty generic program, Elixir members will have access to an expanded list of FDA-approved specialty generic medications at no cost to them, while enhancing our ability to drive optimum savings for the plan.”

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Arbuckle explained that Elixir created a list of specialty generic drugs that are eligible to receive a $0 copay that is continually updated. When determining what generic drugs to include on the list, all financial aspects are considered, factoring in such things as rebates and discounts, ensuring the drugs on the list are the most cost-effective option.

This enhancement is being added to Elixir’s existing managed copay solutions, which tracks copay assistance from manufacturers that are applied to specialty prescriptions, giving members the benefit of assistance to afford branded specialty medications and ensuring clients do not begin bearing the majority of the medication cost before the deductible is actually achieved. In 2021, this program delivered over $25 million in savings, the company said.

“Many people aren’t aware that there are specialty generic drugs available, especially with all of the television ads for the brand versions. Additionally, copay assistance available for most branded specialty drug products often disincentives members from selecting lower-costing generic options on their own. However, utilization of specialty generics can save plan sponsors up to 30% per claim,” Arbuckle said. “Our specialty generic solution allows both the plan and member to save on drug costs, while still receiving the benefit of the potentially life-saving drug. Additionally, these cost savings help to increase member adherence to specialty medications, which can limit expenses from healthcare complications.”

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Elixir provided this example of how this enhancement works — If you have a brand drug that costs $6,000 per claim where an FDA-approved generic costing $2,800 per claim has been identified, the plan sponsor would only pay $2,800 versus $6,000. This results in savings of over $3,000 per claim for the plan and a $0 copay for the member.