The stakes for benefits managers have never been higher. Medical innovation is happening at breakneck speed and at break-the-bank cost. Available gene therapies for diseases like infant spinal muscle atrophy and sickle cell disease, while potentially curative, will cost payers several million dollars for each patient treated. Tried and true tools for utilization management are no longer adequate to create benefit policies. These new interventions defy categorization as either “medical” or “pharmacy”. And, what exactly do the terms, “cosmetic”, “lifestyle”, and “aesthetic” really mean as they pertain to healthcare coverage. NBS Healthcare Group can help employers, benefits administrators and carriers create innovative approaches to plan design and coverage policies. We have the expertise to refresh summary plan descriptions, and assure that they align with company values. We can liaise with insurance carriers to assure consistency between plan design and coverage policy. Our team can review individual claims for appropriate adjudication. NBS can absolutely provide clinical rigor into utilization management rules, to assure patient safety and optimal prescribing.
If your organization is in need of clinical oversight or innovative benefits support, contact us. We’re available to help and are committed to efficient and effective consulting services.