pca overview
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“PCA – Your Prescription For SavingsSM”
Company Overview
Prescription Corporation of America (PCA) is a rapidly growing Pharmacy Benefit Manager (PBM) located in Denville, New Jersey.
Since launching operations in January 2011, we have added over 80 private and public sector clients.
PCA has created a pharmaceutical pricing, delivery and systems model that benefits plan sponsors and patients, rather than prescription drug program administrators.
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PCA’s mission is to reduce and control prescription drug costs for
our clients, while improving the quality of care for the members and
families we serve.
Our experience has shown we can achieve annual savings of 8% to 11% in prescription drug program
costs for our clients.
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Retail Pharmacy Prescriptions Mail Order Home Delivery Service Patient Empowerment Program
(PEP) Prescription Discount Cards Non-Profit Drug Programs
PCA provides comprehensive PBM services including:
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Expert benefit management, plan design, and cost control Efficient retail claims processing within our nationwide network
of 64,000+ pharmacies Ability to guarantee claim rates through reinsurance 24/7/365 Customer Service where you speak to a real live
person who has a personalized focus on your members and their families
Mail Order Home Delivery Service from our Denville, NJ pharmacy
Patient advocacy and education Business model firmly based on transparency and proactive
benefit cost management
Service Highlights – How PCA accomplishes its mission
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PCA administers plans for many types of clients: Commercial clients including employer groups of varying sizes in a
broad range of industries Business associations, chamber of commerce organizations, and
trade groups All levels of government entities (towns, counties, and school
boards) Labor groups, unions, welfare funds, and Taft Hartley plans Charitable organizations and other qualified non-profits
with over 23,000 union members
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Self Insured – our relationship with reinsurers allows us to offer guaranteed claim rates, along with full transparency and 100% return of manufacturers’ rebates.
Fixed Cost – access to reinsurance enables us to offer the most effective fixed cost, capitated, fully funded plans.
Rx $avings $olutions – these affordable plans feature generic only or generic and preferred brand formularies, allowing us to provide lower cost alternatives than our competitors.
PCA Prescription Savings Card – this program enables members and their families to realize savings of 15% to 75% on prescription drug purchases through a nationwide network of over 62,000 pharmacies.
Patient Empowerment Program (PEP) – this voluntary clinical management program provides members with a CASH incentive to try brand-to-generic substitutions and therapeutic brand alternatives.
PCA Non-Profit Drug Program – allows non-profits to purchase medications at the lower cost hospital acute care “Class of Trade” rate.
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These programs are complimented by our formulary management, clinical programs (including Medication Therapy Management (MTM) and Step Therapy), 24/7/365 live customer service, and consultative services focused on opportunities to maximize savings.
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PCA Programs
While PCA’s growth allows us to leverage major alliances and relationships with pharmaceutical manufacturers, we remain focused on personalized customer service for our clients and
members. ____________________________________________________________________________________________________________________________________________
Lower Program Costs - As a true client advocate, PCA’s programs, plan designs, and pricing achieve the lowest drug program costs without sacrificing quality of care.
Reinsurance – Our alliance with reinsurance providers allows us to guarantee savings, or administer effective fixed cost plans.
Consultative and Administrative Services – PCA will help you select your formulary and plan design from our many options. Our analytic and reporting tools, combined with our expert analysis, will maximize your savings opportunities.
Our Pharmacy Network – PCA’s network features over 64,000 pharmacies nationwide. We also have a Preferred Network option with over 20,000 pharmacies allowing for deeper discounts.
Claims Processing - Our partnership with Argus Health Services provides state-of-the-art electronic claims adjudication capabilities. Argus currently processes over 500 million pharmacy claims a year.
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Our Competitive Advantages
PCA’s Mail Order Home Delivery Pharmacy is located
at our Denville, NJ headquarters and designed to take advantage of the lowest purchasing prices available,
allowing us to pass along these savings to our clients
and members.
Unlike other PBMs that have outsourced mail order
arrangements, PCA’s pharmacy facility is
operated by our in-house pharmacy team. Your plan members can access all the details of this program and
get started through our website at www.hca-
pca.com.
Mail Order Home Delivery
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Customer Service
PCA’s multi-lingual, 24/7/365 live customer service capabilities for providers and members feature personalized service tailored to your plan design. We deliver
"real-time" access to plan information and out-of-pocket expenses, as well as clinical information on the proper utilization of medications.
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www.hca-pca.com
PCA continues to develop our user-friendly website,
www.hca-pca.com, with the latest
information on our programs and
formularies, our Mail Order Home
Delivery Program, a pharmacy locator, the ability to price
and compare medication costs, clinical programs, and updates on
new PCA initiatives.
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ANNUALIZED$2,830,369
PCA MAIL-ORDER (THERAPEUTIC
SWITCH)$104,254
RETAIL (THERAPEUTIC
SWITCH) $2,027,989
PRIOR AUTHORIZATION COST-OVERRIDES
$45,467RETAIL (GENERIC
SWITCH)$646,611
PCA MAIL-ORDER (GENERIC SWITCH)
$6,046
Savings Beyond Pricing AdvantageHere is a breakdown of savings achieved on a program with total costs of $21 million
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PCA Case Studies Here are a few examples of recent results:
Regional High School with 500 employees: 11% savings based on insured renewal of fixed-cost program with 12 month rate guarantee.
New Jersey County with 3,400 employees:$546,000 in guaranteed savings for self funded program based on hard-dollar claim cost reduction.
Non-Profit Association with 33,000 members:18-55% savings on prescription purchases with discount savings card provided free of charge to all members.
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Regional High School with 500 employees: Fixed-cost program with twelve-month rate guarantee and 9.88% savings based on insured renewal.
Enrollment Incumbent PCA
RatesAnnual
Premium RatesAnnual
Premium
Single $134.28 $273,931 $121.02 $246,881
Parent & Child(ren) $288.12 $107,181 $259.66 $96,594
Two Adults $319.94 $345,535 $288.34 $311,407
Family $385.92 $879,898 $347.81 $793,007Dependents Age 26 – 31 $81.64 $16,655 $73.58 $15,010
Annual Fixed Cost $1,623,199 $1,462,899
Percentage Savings 9.88%
Total Dollar Savings $160,301
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PCA Savings Illustration
Here are the initial questions we ask: How much does your Rx Benefit Plan cost per year? Is it part of your medical plan or administered
separately? Is it self funded or does it have monthly fixed rates? May we develop a formal proposal with guaranteed
savings?
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Basic Survey
Same Plan Design No Change of
CoPay Covered Medications Exclusions
Benefit Equivalency Letter
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Benefit Equivalency
Sample Cards
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PCA Prescription Savings Cards
For program information, e-mail:
Or call
(973) 983-6300
66 Ford Road
Suite 230Denville, NJ
07834www.hca-pca.com
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