pca overview

18
“PCA – Your Prescription For Savings SM Company Overview

Upload: broefaro

Post on 13-Dec-2014

341 views

Category:

Documents


0 download

DESCRIPTION

 

TRANSCRIPT

Page 2: PCA 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.

2

Page 3: PCA Overview

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.

3

Page 4: PCA Overview

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:

4

Page 5: PCA Overview

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

5

Page 6: PCA Overview

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

6

Page 7: PCA Overview

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.

____________________________________________________________________________________________________________________________________________

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.

7

PCA Programs

Page 8: PCA Overview

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.

8

Our Competitive Advantages

Page 9: PCA Overview

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

9

Page 10: PCA Overview

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.

10

Page 11: PCA Overview

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.

11

Page 12: PCA Overview

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

12

Page 13: PCA Overview

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.

13

Page 14: PCA Overview

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

14

PCA Savings Illustration

Page 15: PCA Overview

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?

15

Basic Survey

Page 16: PCA Overview

Same Plan Design No Change of

CoPay Covered Medications Exclusions

Benefit Equivalency Letter

16

Benefit Equivalency

Page 17: PCA Overview

Sample Cards

17

PCA Prescription Savings Cards

Page 18: PCA Overview

For program information, e-mail:

[email protected]

Or call

(973) 983-6300

66 Ford Road

Suite 230Denville, NJ

07834www.hca-pca.com

18