Cost Plus Rx Reimbursement Model

A cost plus Rx (NADAC + dispensing fee) reimbursement model makes sense…………….

We offer independent pharmacies a simple reimbursement formula that is based on a cost plus model. For each successful claim, you will be reimbursed at the published NADAC list price for ingredient cost plus a fair and financially sustainable dispensing fee.

We also provide the unique opportunity for additional revenue by completing alerts via our clinical platform and giving you access to data rarely seen in community pharmacies

Self-Insured Pharmacy Networks (SIPN) is a pharmacy benefit manager (PBM) based in North Carolina that brings a nationwide network of independent pharmacies using our customized cost-plus model to save self-funded employers on drug costs.

Unlike traditional PBMs, SIPN will not mark-up the cost of prescription drugs, will not take advantage of spreads, and will definitely not withhold any rebates from employers. Instead, we are 100% transparent, billing clients the national average drug acquisition cost (NADAC) plus a flat dispensing fee. Additional fees are generated from ancillary services such as clinical programs that are additional and fully disclosed on a PEPM basis. This is different from our direct competitors in that they mark-up ingredient costs, take advantage of spreads, and participate in secret rebating thus hiding cash flows from employers.

Our unique cost-plus reimbursement model (NADAC + dispensing fee) ensures a near 0% margin on drug ingredient costs compared to inflated list prices when using AWP, MAC, and WAC formulas. We ask employers to pay for the value in pharmacy services and change the thinking about healthcare as a commodity. When we eliminate drug ingredient margins, employers can rest assured they are getting the best price for their employees and shifting payment in a 100% transparent manner to the clinical value a pharmacist provides to their patients.

We promote our pharmacy services to self-insured employers primarily through health insurance brokers, benefits consultants, and third party administrators.

The Self-Insured Pharmacy Network (SIPN) competitive advantage is to provide 100% pharmacy spend clarity with our cost plus model and use the clinical knowledge as a pharmacist owned PBM to employ insider expertise cost saving strategies. The complexity and opacity of traditional PBM contracts are misaligned with the interests of self-insured employers. Our reimbursement to pharmacies for every prescription claim is NADAC (National Average Drug Acquisition Cost) + a fixed flat dispensing fee. No other margin or cost is charged to the employer from a pharmacy perspective.

 

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