With concerns mounting about how health plan sponsors will pay for breakthrough treatments with ultra-high price tags, some major insurers are offering up new solutions aimed at easing that burden.

Two newly approved narcolepsy medications offer novel, possibly more effective options to people for whom older medications aren’t working well, but most plans are requiring patients and providers to try generic alternatives first.

While some of the options on the table for redesigning Medicare Part D would place a lot more financial risk onto plan sponsors, there are reasons to believe that the consequences of such a shift might not be that severe.

Magellan Rx Management says that members who use its MRx Specialty Pharmacy are significantly more likely to reach and maintain adherence goals of 85% or greater, in large part due to motivational coaching from nurses. But one industry expert says he would want to see more data before reaching conclusions about the program’s effectiveness.