Payer Matrix

Company Snapshot

Driving Healthcare Savings to New Heights

Our History

Payer Matrix was founded in 2016 as we saw a critical need for a solution to address the rising specialty drug costs and their impact on plan budgets. Our founder and the senior management team have significant experience in the healthcare industry, focused on specialty pharmacy, home infusion, and employee benefits. This experience gives us the unique ability to provide specialized patient advocacy services and ultimately reduce the drug spend to the plan in a meaningful way. As a company, we’ve invested in our human capital, infrastructure, and processes to ensure consistent and quality service. We employ over 100 full-time staff dedicated to alternative funding and member services, operating out of four offices providing national coverage. All services are performed in-house by Payer Matrix employees, and no member services are subcontracted. Our coordinators have the experience and expertise to drive market-leading performance and results.

About Us

350+ Plans on service

4,000+ Members on Specialty 325,000+ Total Covered Lives

100+ Dedicated In-house FTEs

Finding a Strong Partner

Specialty medications have provided significant clinical breakthroughs in a variety of disease states, but that clinical success came with a very high price tag. Typically, only 2-3% of members and 1% of claims account for 35-60% of prescription drug spend for an average self-funded plan. Our patient advocacy program specifically addresses specialty drugs for both the pharmacy and medical benefits and provides significant potential savings to the plan.

Specialty Drug List

Focused on 300+ singlesource specialty brands, including rare/orphan drugs

Alternate Funding/Sourcing

Leverage several forms of assistance, including PAP, CAP, foundations, and other methods

Strong Partnerships

Established partnerships and integrations to streamline operations (PBMs, TPAs, Stop-loss)

Real Savings and Best-in-Class Service

Our team of Reimbursement Care Coordinators are at the heart of our operations and work directly with members, plan sponsors, physicians, and other providers to provide concierge-level patient advocacy resulting in best-in-class member experience. Members experience a seamless transition to our program and clinical treatment plans remain the same – there is no compromise in clinical care whatsoever. We also believe that if we don’t do our job and save the plan money, we don’t get paid. Our performance-based pricing model has no upfront fees for implementation and onboarding or any fixed monthly fees for comprehensive reporting and analytics. Our results speak for themselves.

>90% funding success rate >$100 million in plan savings

Payer Matrix, LLC (877) 305-6202 www.payermatrix.com

HCAA Executive Forum Sponsorship Guide Fall 2022 | 55