THE $0 CO-PAY INITIATIVE: A COMMITMENT TO AFFORDABLE HEALTHCARE AMID RISING COSTS By Don Anderson, PharmD and Vice President, Health Management and Clinical Services, PinnacleRx Solutions
Healthcare costs continue to rise at unprecedented rates, presenting significant challenges for individuals and businesses. At Western Growers Assurance Trust (WGAT), we understand the burden these costs can place on our members, especially those working in the fresh produce industry who face unique health demands. That’s why we are proud to announce an enhancement to our prescription drug program: a zero dollar co-pay for generic medications at Walmart or Costco pharmacies. This initiative is part of our ongoing commitment to providing more affordable healthcare options to our members. Addressing Rising Healthcare Costs The introduction of our $0 co-pay program comes at a crucial time. We are witnessing unprecedented spikes and drops in the costs of various medications. For instance, the cost of biologics used to treat cancer has increased by 34 percent by volume, with newly approved cancer drugs now averaging an annual cost of $297,000—up 59 percent since 2019. Similarly, the costs for new treatments for eye diseases, such as macular degeneration, have risen by 38 percent, with annualized patient costs ranging from $18,800 to $23,400. The GLP class of drugs initially used to treat diabetes (Ozempic, Wegovy, etc.), has seen a significant expansion in patient reach. This is largely attributed to the new treatments approved for conditions, such as sleep apnea, kidney disease, heart failure and Alzheimer’s. This could potentially affect 134.5 million patients, with financial implications running into the tens of billions. Blockbuster medicines like these need a well-crafted pharmacy benefit management (PBM) strategy to ensure efficient spending and use. Amid these rising costs, the arrival of biosimilar drugs offers a glimmer of hope. For example, new biosimilars for the drug Humira are expected to reduce annual treatment costs from $62,500 to $9,750 per patient. This could save approximately $9 billion in the U.S. alone. At WGAT, we believe that deploying a well-crafted substitution strategy for these biosimilars is essential to capturing savings without compromising patient outcomes.
The New $0 Co-Pay Program Starting Jan. 1, 2025, WGAT health plan members can access generic medications with a zero dollar co-pay at any Walmart or Costco pharmacy. And with thousands of Costco and Walmart pharmacies nationwide, it’s easier than ever for our members to fill their prescriptions. This extensive network ensures that our zero dollar co-pay benefit is not only affordable but also effortlessly accessible. This benefit applies to both 30-day and 90-day prescriptions, offering flexibility and convenience. Importantly, no Costco membership is required to use their pharmacy services. Our Commitment to Affordable Healthcare Our zero dollar co-pay initiative is a testament to our commitment to making healthcare more affordable and accessible for everyone. We’re dedicated to doing more for our members and their employees and the new program is just one example of how we strive to do so. By offering generic medications at no cost, we aim to ease the financial burden on our members, allowing all to focus on their health and well-being. Looking Ahead As we move forward, WGAT will continue to explore new ways to support our members in managing their healthcare needs. We recognize the importance of staying ahead of rising costs and ensuring that our members have access to the medications and healthcare they need without breaking the bank. Our focus remains on delivering high-quality, affordable healthcare options that meet the unique needs of those in the fresh produce industry. Our “No-Pay Co-Pay” program is a significant step toward reducing healthcare costs for our members. We are excited about this new offering and believe it will make a meaningful difference in the lives of those we serve. We encourage our members to take advantage of this benefit and start saving on their generic medications. For more information about the $0 co-pay program and how to transfer your prescriptions, contact the customer service team and PinnacleRx Solutions at (866) 695-3309.
33 Western Grower & Shipper | www.wga.com September | October 2024
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