New Prescription Coverage Coalition Reveals PBM & Unique Contract Terms

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After conducting a 6 month RFP with 25 PBMs competing to win the RFP, the National Prescription Coverage Coalition today announced that its first PBM will be Envision Pharmaceutical Services.The Coalition's executive director also described several of the unique contract terms that will result in dramatically lower prescription coverage costs for all Coalition Members.

New Coalition Offers Dramatically Better Pricing & Guarantees
Compare the Coalition's contract terms with Envision with your own PBM contract terms, and you'll immediately realize why joining the Coalition will result in dramatically lower prescription coverage costs.

The National Prescription Coverage Coalition today announced that it has executed a contract with the PBM Envision Pharmaceutical Services, which has agreed to provide services to all new Coalition Members based on a unique contract that will dramatically reduce Coalition Members' costs.

Accordingly, by joining the Coalition, every corporate, union and municipal health plan sponsor will benefit immediately simply by taking advantage of the Coalition's already-negotiated, unique contract terms, which are detailed on the Coalition's website.

The Coalition's Unique Specialty Drug Terms

"Every plan is struggling to control the costs of Specialty Drugs, which represent 1% to 3% of all drugs taken, but 15% to 25% of total drug costs," explained Linda Cahn, the Coalition’s Executive Director. "The Coalition's contract with Envision mandates a Minimum Discount Guarantee for every Specialty Drug in the marketplace - a total of 850+ drugs."

The importance of the Coalition's aggressive Specialty Drug pricing is clear, added Cahn.

"Most PBM / client contracts today provide guaranteed discounts on only about 100 to 200 Specialty Drugs. A few contracts offer discounts on 400 to 500 Specialty Drugs. But that still leaves PBMs free to charge inflated prices on hundreds of Specialty Drugs. Moreover, almost no contracts contain any price controls over new-to-market Specialty Drugs,” said Cahn.

As Cahn further explained: “Unless every Specialty Drug has a guarantee - and the guarantee is aggressive - your plan's costs are unlikely to be contained and instead will likely skyrocket.”

The Coalition's Unique Generic Drug Guarantees

The Coalition's executive director also revealed how the Coalition’s contract will ensure that every Coalition Member will obtain lower generic drug costs as a result of another set of unique contract guarantees.

The Coalition's contract contains two, different generic drug Ingredient Cost guarantees – for each of the 3 pharmacy venues (retail, retail 90 and mail) - meaning 6 such guarantees in total. The first type of guarantee is for those generic drugs that have just entered the market, when the generic drugs are typically quite expensive. The second type of guarantee, which is far more aggressive, is for all other Generic Drugs. By subdividing generic drugs between those two categories, the contract provides far stronger guarantees for virtually all generic drugs.

The contract also contains unique Commonly Used Generic Drug Guarantees. Linda Cahn explained why: "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, but those drugs should have average costs of no more than $15 to $25 per prescription." Cahn added: "Given PBMs' inflated prices, when plans create incentivizes for their members to use low-cost generic drugs, it's PBMs - not plans - that reap the largest financial benefits." The Coalition's Maximum Price Guarantees for certain Commonly Used Generic Drugs will protect every Coalition Member from PBMs' typical price gouging on these Commonly Used Generic Drugs.

Linda Cahn also described the savings that will result from the Coalition’s contract terms concerning Prior Authorization, Step Therapy and Quantity Limit Programs. Envision has agreed to provide far more extensive reporting, including detailed approval/disapproval Prior Authorization reports. And the Coalition has the right to carve-out any of these Programs and rely on a third party vendor, should the Coalition want to do so.

Envision’s Unique Rebate Terms

Envision also agreed to provide every Coalition Member with a 100% pass-through of all financial benefits – not just rebates – from all third parties – not just drug manufacturers.

Moreover, unlike all other PBMs, Envision agreed to pass through all third party financial benefits that are earned during an Invoice period, when each Invoice is transmitted.

Thus, rather than waiting for the usual 9 to 15 months to collect rebates, every Coalition Member will collect not only rebates, but all other third party financial benefits in a timely fashion.

Coalition Member Benefits

Unlike other Coalitions, the National Prescription Coverage Coalition will be providing its Coalition Members with ongoing and continuous services from the Coalition's staff of experts.

The Coalition will conduct an automatic Set-Up Audit after each Coalition Member begins coverage to try to ensure that every Coalition Member's Benefit Plan Design is accurately loaded into the PBM's computer systems.

Coalition experts will also scrutinize an extensive set of claims data for every Coalition Member every month. That task can be accomplished because the Coalition's contract mandates that a complete set of 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 (i) review available pricing for new - and old - Generic Drugs and Specialty Drugs, (ii) negotiate quarterly with Envision to update and improve pricing, and (iii) work with Coalition Members continuously to tailor their Savings Programs to adjust to marketplace changes.

"Given the ongoing and relentless changes that are taking place in the drug marketplace, clients can't possibly keep up with all the information that's needed to control their costs," said the Coalition's executive director Linda Cahn. "But our Coalition experts will do so, and will be in regular contact with every Coalition Member to make sure each is positioned to react to new developments to control its costs."

The Coalition is offering a free consultation to every corporation, union and municipal entity that wants to learn more about the Coalition's unique arrangement with Envision. "We are confident if you compare the Coalition's new contractual terms to those being offered by any other PBM in the marketplace, you'll quickly realize why joining the Coalition will result in dramatically lower prescription coverage costs," says Cahn.

For more information about the National Prescription Coverage Coalition, contact the Coalition at 973 975-0900 or visit the Coalition's website.

A detailed description of the Coalition Services that will be provided to all Coalition Members can also be found on the Coalition's website.    

Entities that want to obtain tips on how to control prescription coverage costs can also sign up on the website to receive Free $$$-Saving Drug Alerts.

About Envision Pharmaceutical Services

Established in 2001, Envision Pharmaceutical Services (EnvisionRxOptions) is a national, full-service pharmacy benefit management company. A portfolio company of TPG, a leading global private investment firm with $66 billion of assets under management, Envision is part of a group of healthcare management companies owned and operated by Envision Pharmaceutical Holdings LLC (EPH), a privately held company with consolidated revenues in excess of $4 billion.

EPH subsidiaries include (i) Envision Insurance Company, a fully insured provider of Medicare Part D Plans nationally; (ii) Envision Medical Solutions, LLC, an administrator of prescription savings plans and Prescription Savings Cards; (iii) Orchard Pharmaceutical Services, LLC, a full-service mail-order and specialty drug pharmacy; and (iv) Design Rx, LLC, a market leader in pharmacy services for infertility and fertility.

Envision - founded on a commitment to provide full transparency and disclosure in the PBM marketplace - employs a transparent, pass-through business model in which 100% of earned rebates, discounts, and incentives are instantly credited at the point of sale to customers, for which Envision charges a low, flat monthly management fee for most services. This translates into significant savings for the company’s more than 20 million covered individuals.

Envision has been awarded the Utilization Review Accreditation Commission (URAC) accreditations for PBM and Drug Therapy Management annually since 2007. Envision is headquartered in Twinsburg, OH, with offices in Fort Lauderdale, FL; Tampa, FL; Canton, OH; El Dorado Hills, CA; and Ogden, UT.

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