With advances in research and drug development come novel and innovative therapies for many disease states offering patients new treatment options. Unfortunately, many of these new therapies have accompanying price tags that range between $20,000 - $300,000 per year, rendering them unaffordable for most in the absence of employer-sponsored prescription drug benefit plans.
As benefit plans across Canada face escalating cost pressures, many are looking for ways to better manage their coverage – to preserve both access for their employees as well as the long-term sustainability and affordability of their plans by ensuring the right drug, for the right person, in the right dose, at the right time.
Cubic’s FACET Program for prior authorization of specialty medications is unique and represents the new disease-state based standard for complex, high-cost claims management. A Cubic Clinical Pharmacist reviews and adjudicates each claim for an expensive specialty drug for employees and their families from end-to-end, using a novel disease-state based approach with the latest evidence-based criteria and clinical guidelines.
40% of all initial claims or “new starts” received by FACET require active clinical intervention by Cubic’s Clinical Pharmacy team.
For example, it could be that the medication prescribed is not an appropriate first-line therapy according to current treatment guidelines, or there is concern with respect to the dosage prescribed. Regardless of the reason, there is a growing need for independent clinical assessment of these complex claims.
Plan members receive decisions within 2 business days of FACET receiving all the necessary clinical information. The results to date have helped plans continue to afford necessary high-cost therapies and benefitted plan members who have their claims reviewed by independent experts.
FACET has been in place since 2015 and provides service to more than 300,000 employees across Canada.