As a student health insurance plan dedicated to students, we’re continually focusing on ways to make healthcare more affordable for students. Wellfleet Rx, our proprietary student pharmacy solution, focuses on saving students money on their specialty medications.
In the fourth quarter of 2023, the copay assistance program secured more savings than ever before. The program produced plan savings of about $2,200 per utilizing member for the quarter, which translates to nearly $9,000 savings per utilizing member per year.1
In this blog, we’ll discuss how our copay assistance program works, who’s eligible, and how it benefits students and schools.
How does the copay assistance program work?
The Wellfleet Rx copay assistance program helps students to navigate and receive manufacturer copay assistance for eligible specialty medications. These programs lower student member and plan costs, benefiting the student and school.
When a student is enrolled in the program, students’ copays may be reduced significantly, often as low as $0-$10. Because the programs utilize manufacturer copay assistance, the manufacturer pays the difference, which results in savings for both the plan and the student.
You may be wondering why drug manufacturers have these assistance programs. These programs are widely available for specialty medications because these drugs are very expensive. Because of the high cost of these drugs, it’s important to make them more affordable for those who need them. These manufacturer programs improve access to these important specialty medications by lowering members’ cost.
Wellfleet’s copay assistance program does the heavy lifting for the student, helping ensure eligible students can access available specialty medication savings.
Who is eligible for the copay assistance program?
All our partner schools in eligible states are automatically enrolled in the Wellfleet Rx copay assistance program.
For a student to be eligible for copay assistance, they need to be prescribed a specialty medication. Some high-cost specialty medications, unfortunately, do not have manufacturer assistance programs, so they are excluded from the program. When we identify students eligible for the program, we contact them to help them enroll. Our proactive outreach makes it easier for busy students to get enrolled — even if they’ve never heard of the program before.
What are the benefits of the program?
The copay assistance program can benefit both students and schools. Here’s how:
Benefits to students
The primary benefit of the copay assistance program is reducing costs for college students taking specialty medications. By lowering their copays to often between $0 and $10, each enrolled student can save hundreds of dollars per year.
Additionally, these savings are available for both short-term and long-term medications, so students who need to take expensive medications continually can see benefits year after year.
Students are vulnerable during college, with 73% of undergraduate students reporting that they’ve experienced financial difficulty during college.2 This program helps decrease their healthcare costs so they can focus on their studies rather than worrying about medication costs.
Benefits to schools
In addition to helping students save money, the copay assistance program also benefits schools in a few ways. One is by lowering plan costs. When the manufacturer covers most of the medication costs, the plan doesn’t need to contribute as much toward students’ medications. This reduces plan spending during the year, affecting future years’ premiums — which helps combat yearly premium increases.
How the program benefits schools:
- Helps school plan spend decrease by controlling their specialty medication costs
- Helps their students get more affordable meds and increase access to care
- Provides savings of up to 25% of the drug costs for the plan
How else does Wellfleet Rx help students and schools save money?
The copay assistance program isn’t the only way the Wellfleet Rx team helps lower healthcare costs for our student members and schools. Here are a few of the other ways we help reduce medication costs:
Prior authorization
With prior authorization, certain treatments or medications are reviewed by the patient’s insurance company before approval will be given. When we review medication requests, we consider:
- Safety and efficacy of the medication
- Appropriateness of the medication to treat the patient’s condition
- Cost of the medication and whether a less expensive, equally effective alternative exists
During the 2022-23 school year, our prior authorization protocol resulted in an average savings of $47.16 per member per year.3
Quantity limits
Quantity limits are parameters on the amount of medication provided, and they align with the FDA-approved instructions for each medication.
These limits help ensure patients get the right amount of medication for their condition and can also reduce medication costs by avoiding having patients pay for medications they don’t need.
During the 2022-23 school year, we secured an average savings of $17.64 per member per year using quantity limits.3
Step therapy
Another way Wellfleet Rx helps students save money on medications is through step therapy. Patients start with lower-cost medications and only progress to more expensive brand-name medications if the lower-cost options fail.4
During the 2022-23 school year, our step therapy protocols resulted in average savings of $8.64 per member per year.3
Learn more about how Wellfleet Rx used prior authorization, quantity limits, and step therapy to save an average of $73 per member per year.
Learn more about Wellfleet’s formulary created for students
Created for students, Wellfleet Rx tailors our formulary to the unique needs of college students. We focus on offering our members the right medications at the right price — that’s why we provide 50+ medications with a $0.00 copay.
Connect with us to learn more about how Wellfleet can create a tailored health insurance plan and pharmacy solution for your students.
References
1 Wellfleet (2024). IPC Copay Assistance Savings Report – Wellfleet. All eligible student health plans in eligible states. Unpublished company document.
2 Fletcher, C., et al. (2023, May). Student Financial Wellness Survey. Trellis Research. https://www.trelliscompany.org/wp-content/uploads/2023/05/SFWS-Aggregate-Report_FALL-2022.pdf.
3 Wellfleet (2023). Outcomes Utilization Management Conversions Plan Year 2022-2023. Retrieved January 26, 2024. Unpublished company document.
4 What is step therapy? https://www.healthinsurance.org/glossary/step-therapy/.
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