Famed Magician Reveals How To Create Rx Savings Out of Thin Air

The cost for a Fully Insured Rx Card is 8-10% of the plan cost. So, if the Stop Loss Carrier carves out 15% for the Rx and the cost for the Fully Insured Rx Card is 10%, you’ve just cut the price of the group plan by 5%. 

By Michael Reagan

As a former owner/operator of several Third Party Administrators, I was always in search of ways to become more efficient as well as reduce costs and risks for my clients and my TPA.  I had the pleasure of working with some great PBMs (Pharmacy Benefit Managers) and unpleasant experiences with those that were not great or even good.

Here are some of the challenges I faced: (True Stories)

·     Group paid late….I receive a call from the PBM’s CEO “I am not a Bank….I need to be paid now”!  My response: “Yes, as soon as I get paid you will get paid. PBM CEO, “Well, I need you to tell the employer you are turning off their Rx card until I get paid”!  Not a pleasant call.

·     CSR gets a call from a member – “I am at the pharmacy…my Rx Card doesn’t work…my child is sick!” CSR calls PBM – states all is good…” just have the pharmacist rerun the card”…..it still didn’t work! Member’s Dependent will not talk to the PBM… only to our CSR. Member’s Dependent hangs up and calls their Spouse at work, who calls his Boss, who calls Broker, who then calls me wanting to know what is wrong with the PBM that I put them with. However, during the time of this call, my CSR and the PBM’s CSR have fixed the issue. Member’s Dependent gets Rx for their child, but doesn’t call anyone to let them know their problem has been resolved… just goes home while I spend the next 45 minutes trying to see what happened. I call the Broker back who will only call the employer back with me on the call… not a pleasant call.

·     CSR gets a call – Drug is not on Formulary… No Discount wrap. The employee wants to know why his Rx Card is not worth the paper it is printed on. No one wants to tell the employee that his/her Boss wanted the cheapest Rx program with the most limited Formulary that the PBM had. The PBM didn’t include a Discount wrap plus the PBM doesn’t offer any assistance with MFG Coupons, discounts, or any kind of wholesaler that could reduce cost. Employee only wants to talk with me…. not a pleasant call.

Well, I found a Solution! Our Guaranteed Acceptance, Fully insured card with an 88-92% discount on many of the top 50 prescribed meds to the rescue! They handle the Service Calls and billings, plus, they take on the Fiduciary responsibility for the TPA and the client!  If the group pays late, theydeal with our PBM, not the TPA. If the Rx Drug Card is turned off, the employees deal with our PBM, not the TPA. Also, our PBM can provide a Discount Card Wrap on all programs, so No One ever pays retail on Rx again!

Specialty Drugs for a nominal fee can be added to any program. What is a Specialty Drug? Any Drug $1,000.00 retail and over.

Who administers this unique program? PRAM—the only Fully Insured, guaranteed acceptance Rx Card on the market today that is backed by an A+ Superior rated insurer, so you know the monies will be available to pay claims.

Remember, I said I wanted to reduce costs and risks for my clients? – with PRAM you can! Go to your Stop Loss Carrier and have the Stop Loss Carrier carve out, out-patient Rx. Most carriers load 15-20% for the Rx. The cost for the PRAM Fully Insured Rx Card is 8-10% of the plan cost. So, if the Stop Loss Carrier carves out 15% for the Rx and the cost for the PRAM Fully Insured Rx Card is 10%, you’ve just cut the price of the group plan by 5%. A 5% reduction could get you a NEW Group or keep a Group at Renewal.

Just to recap:

  •      The Employer/Group deals directly with PRAM, not the TPA.
  •      The employees and their covered dependents deal with PRAM’s CSR’s, freeing up the TPA’s CSR’s on Rx issues.
  •    PRAM can take care of the billings, so, if an employer/group pays late and the card is turned off, it’s not the TPA’s issue to handle.
  •    PRAM takes the Fiduciary responsibility away from the TPA and the clients on all out-patient Rx related matters.
  •   PRAM can include their Discount Wrap that includes Pet Meds, some OTC meds, and Specialty meds on all PRAM products, so no one pays retail even if meds are not in the formulary!

* Call 214-850-1069 or 770-654-8499to arrange a meeting with the former TPA owner/operator.

Editor’s Note: Mike Reagan is one of the smartest people I know in our industry. We both met while working for the same insurance company back in the 70’s.