New Prescription Coverage Coalition Launched

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Health Plans confronted with ever-increasing prescription coverage costs - but that are about to allow their PBM contracts to renew automatically for another year - now have a better alternative: Join a unique new Coalition that will immediately and dramatically lower their costs.

New Coalition Offers Dramatically Better Pricing & Guarantees
The Coalition's unique contract eliminates all the loopholes that are stuffed in other PBM contracts and thereby guarantees savings for every new Coalition Member.

A nationally recognized consulting firm is launching a new Coalition - the National Prescription Coverage Coalition - after conducting a six month RFP with more than 20 Pharmacy Benefit Management companies competing to win the RFP.

The consulting firm - Pharmacy Benefit Consultants - reports that several corporate, union and municipal Health Plans are already conducting discussions to join the new Coalition.

Unique Coalition Contract Terms

"We are confident that the Coalition has negotiated the strongest PBM contract terms that are available in the nation," says Linda Cahn, the Coalition's executive director. "As just one example, the Coalition's PBM contract contains a list of more than 850 Specialty Drugs, with an aggressive Minimum Guaranteed Discount for every listed drug. Most PBM contracts today provide discounts on only about 100 Specialty Drugs, leaving the PBM free to charge inflated prices on all other Specialty Drugs."

Other Coalition benefits are equally striking. The new Coalition contract imposes an automatic guaranteed discount on every new-to-market Specialty Drug. In contrast, virtually all PBM/client contracts entirely ignore the cost of these drugs. Since more than half of all new drugs approved by the FDA in 2013 were Specialty Drugs, an automatic discount on these drugs' costs is critical if a Health Plan wants to control its costs in the future.    

The Coalition also imposes a Maximum Cost Guarantee on certain commonly used generic drugs. "Unbeknownst to most PBM clients, PBMs routinely charge their clients an average of $80 to $100 per prescription for the generic versions of drugs like Lipitor, Prozac and Zoloft, even though these generic drugs should cost no more than $25 per prescription," says Cahn. "Given the Coalition's Maximum Price Guarantees, our Coalition Members will be protected against such price gouging. And they will be guaranteed low costs every time these commonly used generic drugs are dispensed."

Coalition Members will also decrease their costs, because the Coalition requires its PBM to pass through 100% of all financial benefits - not just rebates - that the PBM receives from all third parties - not just drug manufacturers. As a result, Coalition Members will save money even if the PBM re-labels its third party revenues as "administrative fees" or "health management fees" instead of calling them "rebates" - and even if the revenues come from wholesalers or distributors rather than drug manufacturers.

Coalition Member Benefits

Unlike other Coalitions, the National Prescription Coverage Coalition is also guaranteeing that its Coalition Members will receive continuous support from the Coalition's staff of experts.

For example, after implementation, the Coalition will automatically conduct a Set-Up Audit to ensure the PBM accurately loads into the PBM's computer systems the Coalition Member's Benefit Plan Design.

Coalition experts will also scrutinize every Coalition Member's claims data every month. That task will be facilitated by the Coalition contract's requirement that extensive, specified claims data must accompany every Invoice and must be transmitted to every Coalition Member as well as to the Coalition's experts, or the Invoice need not be paid.

Coalition experts will also continuously review the PBM's retail and mail prices for newly-available Generic Drugs to ensure the PBM is reducing its invoiced costs for those drugs as their prices fall. If the PBM fails to do so, the Coalition's experts will negotiate with the PBM and agree upon better prices for all such drugs, for every Coalition Member.

The Coalition's experts will also monitor all changes in the marketplace and continuously advise every Coalition Member about new programs to control their costs. "Clients can't possibly keep up with all the new drugs - and new information about old drugs - circulating in the marketplace," says Cahn. "But our Coalition experts will do so, and will make sure that every Coalition Member is able to appropriately react to these new developments to control costs."

Every Coalition Member will also benefit from an annual audit - conducted by a top audit firm in the nation - to ensure that every Coalition Member has fully received the benefits of the Coalition contract's numerous pricing terms and guarantees.

Coalition Member Autonomy

Notably, even though a Coalition Member is joining a Coalition, every Coalition Member will be able to customize its coverage and implement its own Benefit Plan Design and its own savings programs, and thus retain complete autonomy over its coverage.

Additional benefits of the Coalition's contract - and additional services provided by the Coalition - are outlined on the Coalition's new website.

The Coalition is also providing a Free Drug Alert that will describe new drug developments in the marketplace for anyone who signs up to receive the Alert.

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