Cost Plus Rx Model For Self-Funded Health Plans

We bring you a network of independent pharmacies with a simple and unique pharmacy payment model. Our cost plus model reimburses drug costs via the nationally published public NADAC list and a fixed drug dispensing fee. No more arcane acronyms like MAC, AWP, and WAC and no more lengthy contracts detailing complex generic and brand definitions.

Editor’s Note: If you are in the pharmacy business I would like to hear from you – any comments or suggestions you may have I will post in a follow-up blog posting………….Rx costs are out of control and the PBM world doesn’t seem to care. Perhaps PBM’s are the bad guys? If not, convince me please………………Write to RiskManager@RiskManagers.us

PBMs profit excessively from hidden revenue streams such as DIR fees, secret rebating, and spread pricing leaving plan sponsors overpaying for their pharmacy benefit management service.

Concurrently, independent community pharmacy owners and pharmacists are unable to provide high quality patient care due to the constant pressure from shrinking drug reimbursements primarily from pharmacy benefit management companies.

Independent pharmacies and self-insured employers are facing declining reimbursements and increasing healthcare costs, respectively.

Solution
SIPN aims to circumvent opaque pharmacy benefit management companies and directly connect independent pharmacies and self-insured employers to reduce costs and improve the quality of care for employees subsequently reducing total medical spend.

SOLUTIONS FOR PHARMACIES

SOLUTIONS FOR SELF-FUNDED EMPLOYERS

Nearly 8 out of 10 payers are overspending by 15% or more on pharmacy benefits, according to a recent survey1. Some of the main causes of payers’ unrestrained remuneration for pharmacy benefits include:

1 LinkedIn article by Tyrone D. Squires https://www.linkedin.com/pulse/employers-guide-better-pbm-performance-tyrone-d-squires

  • Specialty Medication
  • Pharmacy Benefit Manager Contracts
  • Plan Design Strategy
  • Employee Demographics and Dynamics

SIPN partners self-funded employers with independent pharmacies across North Carolina to provide a 10 to 20% savings on drug costs and integrating the community pharmacist back on the medical care team to reduce employers total cost of care.

We believe that self funded employers can save on pharmacy costs by circumventing misaligned PBM practices. Uncontrolled health care costs are painfully felt by employers every year and every self-funded employer should be aware of the numerous hidden PBM revenue streams.

We bring you a network of independent pharmacies in North Carolina with a simple and unique pharmacy payment model. Our cost plus model reimburses drug costs via the nationally published public NADAC list and a fixed drug dispensing fee. No more arcane acronyms like MAC, AWP, and WAC and no more lengthy contracts detailing complex generic and brand definitions.

We enable community pharmacies to collaborate with doctors to reduce the total cost of care via our powerful clinical platform. Our online platform allows pharmacies to see chronic medication adherence in real time for each covered employee and sends alerts via fax to the pharmacy if there is an actionable missed adherence opportunity daily. This in turn improves medication adherence for your employees and reduces the risk of hospitalizations thereby reducing your total cost of care. The platform also allows pharmacies to reconcile medications after an employee is discharged from the hospital to prevent re-admissions and inform all participating prescribers of any changes to an employee’s medications. Finally community pharmacists provide targeted and standardized disease management counseling and any recommendations are sent to the prescriber to ensure optimal chronic care and healthier employees, which leads to reduced lower overall medical costs.

Additionally, we offer consulting and additional services in the following areas:

  • Formulary cost saving review
  • Specialty medication cost saving strategies
  • Audit peer review assistance
  • Patient care performance tracking and reporting
  • Disease management programs
  • Audit protection
  • Prompt pharmacy payments
  • A strong independent pharmacy network in North Carolina with zero drug mark-up costs
  • Rate resolution assistance

Together we can tame healthcare costs and improve the quality of care from the ground up.

We do this without disrupting any current pharmacy networks your employees use today and without having to switch PBM providers

 

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