Balancing Cost and Care: Rethinking Alternative Funding Models in Specialty Pharmacy
As specialty drug costs continue to rise, the pressure on employers, benefit administrators, and patients has never been greater. Golden Triangle Specialty Network (GTSN) is committed to helping stakeholders achieve the delicate balance between economic sustainability and high-quality patient care. By aligning financial strategy with patient outcomes, we support a smarter, more responsible approach to pharmacy benefit management.
The Rise of Alternative Funding Models
In the face of escalating specialty pharmacy costs, Alternative Funding Models (AFMs) have gained traction as a potential cost containment solution. AMFs typically source medications through third-party vendors or manufacturer assistance programs, often outside a plan’s traditional formulary.
On the surface, they’re appealing; they promise immediate cost relief for plan sponsors by sidestepping standard reimbursement channels. For employers and brokers under pressure to reduce spend, they also appear to solve a serious problem. But these models are not without risk, and the burden often falls on patients.
Where AFMs Fall Short: Patient Consequences
As recent reporting has highlighted, some AFMs can lead to a host of downstream issues:
- Surprise billing: A recent Bloomberg article highlighted how patients can face surprise bills, like one woman who was charged $250,000 for treatment she believed was covered, due to medications sourced through non-integrated AFMs.
- Coverage confusion: When medications are sourced outside the health plan, often through third-party vendors, patients may be left in the dark about what’s covered.
- Care disruption: AFMs often operate independently from prescribing physicians and care teams. This disconnect can delay treatment starts, interrupt refills, or cause confusion around medication changes, putting patient outcomes at risk.
- Increased stress: Between surprise bills, unfamiliar pharmacy contacts, and unclear instructions, the experience can be overwhelming when stability matters most.
In many cases, AFMs do not reduce costs, they simply shift them away from the plan and onto the patient. This shortsighted approach undermines the very goals of a benefit plan: to support access, care quality, and long-term financial protection.
Cost Containment Done Right
We believe saving on pharmacy costs shouldn’t come at the patient’s expense. That’s why GTRx, our specialty pharmacy solution, is built on collaboration, clinical coordination, and transparency. We work closely with providers and clients to design smarter programs that deliver real savings without disrupting care or putting members at risk.
A Better Path Forward
The answer to high specialty drug costs isn’t in quick fixes, it’s in sustainable solutions. Plan sponsors must look beyond short-term savings and instead invest in strategies that reduce waste, improve transparency, and enhance care continuity.
GTSN invites benefit leaders to rethink their approach: prioritize models that protect people, not just budgets.
Sustainable Solutions for Specialty Care
At GTSN, we know that lowering pharmacy costs is important—but never at the expense of the people those medications are meant to help. That’s why our specialty pharmacy strategies are thoughtfully designed to deliver real savings while keeping care seamless, transparent, and patient-centered. We’re here to help plans protect both their budgets and their members, with solutions that focus on long-term value, not short-term trade-offs.
Are you looking to protect your members and your bottom line without compromise? Contact Golden Triangle Specialty Network to discover how our solutions can lead to both cost savings and enhanced patient satisfaction.