Our Pharmacy Benefit Management Services. Blue Coast Sample. Pharmacy Benefit Management Proposal June Presented to Cas Sharp

Transcription

1 Blue Coast Sample Pharmacy Benefit Management Proposal June 2018 Presented to Cas Sharp

2 July 27, 2018 Greetings: We wanted a PBM that worked better, so we created one. Southern Scripts addresses the need for simplified, straightforward, and innovative administration of your pharmacy benefits. W e take on two of your biggest challenges: reducing costs and managing utilization. At Southern Scripts, we are focused on delivering significant savings to our clients through straight-forward pricing models and maximizing plan resources through sound clinical management. Southern Scripts is heavily focused on driving down prescription costs. Southern Scripts marries the power of no spread competitive pricing with a high degree of Rx management expertise to lower a client s bottom line. On average, clients of Southern Scripts are seeing a 15% reduction in pharmacy costs after the first year. In turn, these savings are being reinvested into their workforce as new jobs or expanded health care benefits. Southern Scripts gives you back the control and choice as to how to structure your pharmacy benefits to best meet the needs of your employees. It is not a one size fits all approach. We work with you every step of the way to define challenges, create goals, and leverage our industry-leading claims adjudication technology to address your specific needs. Our simple and straight-forward approach coupled with our technology and service makes us ideal to serve selffunded health plans of every shape and size. W e have served a wide variety of clientele from school boards to horsemen, hospitals to shipyards, and local governments to Native American tribes. Our pharmacy management strategy is both innovative and effective. We layer on top of our pass-through pricing the right combination of management strategies that produce substantial savings and a foundation for cost control and healthy growth. On average, clients who maximize the utilization of all our Rx Management strategies see a $20.00 per prescription savings. We know that Specialty Pharmacy continues to be a significant pain point for most employers. Our Variable Copay program is negating the rising trend of 17% increases in specialty costs. Southern Scripts delivers a high degree of personal service and attention to clients and their respective members. We are reworking the traditional pharmacy benefits model and offering new answers to a very important question, How do we offer affordable care to our valued employees? We are Southern Scripts, a new kind of pharmacy benefit manager. Sincerely, LeAnn Boyd, PharmD, CEO Southern Scripts, LLC (318) boyd@southernscripts.net

3 Southern Scripts has a suite of products and services to meet all your needs. Below is an outline of three areas of Southern Scripts that are key to your understanding of our unique model, and all are included in the administration fees. Our Model 100% Pass-Through Pricing 100% Pass-Through Rebates Clinical Pharmacist Management Dedicated Account Management Live, 24/7 Customer Service Nationwide Pharmacy Networks Includes: First Choice, Immunizations and Specialty Also includes: Mail Order and 90 Day Retail Options Our Technology Industry Leading Claims Processing Technology Member Tools & Resources Web Portal & Mobile Applications Reporting & Data Analytics Web Portal & Mobile Applications Quarterly Reporting and Ad Hoc Reporting Invoicing & Provider Payments Our Clinical Management Clinical, Effective Strategies Focused, Clearly defined approaches Customized Drug Benefit Design Unique, targeted clinical management strategies Clinical Pharmacist development and oversight Specialty Pharmacy Solutions Variable Copay, CRX Specialty Program Competitive Specialty Network

4 Southern Scripts Anticipated Effective Rates Retail Pricing Brand (30 Day Supply) AWP-16.5% Generic (30 Day Supply) AWP-78.9% Dispensing Fee $1.50 Brand (90 Day Supply) AWP-18.5% Generic (90 Day Supply) AWP-78.9% Dispensing Fee $1.00 Mail Brand AWP-23% Generic AWP-80.7% Dispensing Fee $0.00 Specialty Pricing Retail/Mail AWP-18% CRX AWP-28% Dispensing Fee $1.50 Based on overall performance rates. Does not include regional differences or most- favored nations rates. (i.e. MA, GA, PR, AK, HI). Price per prescription will be the passed-through price plus any associated taxes less t he member s contribution. There w ill be no margin or s pread pr icing. The rate paid to the participating retail pharmacy will be equal to the amount billed to plan sponsor. Standard Formulary Rebates Brand 1-83 DS $48.80 Brand 84+ DS $ Specialty $ Zepatier $ Select Formulary Rebates Brand 1-83 DS $84.17 Brand 84+ DS $ Specialty $ Zepatier $ % Rebates Passed-Through from third-party rebate aggregator. Based on Single Source Brands only. Claims filled at 340b pharmacies are not eligible for rebates. Based on 3-Tier plan design with $20 copay differential between preferred and non-preferred brands. The Select Formulary is a narrow formulary that requires absolute exclusion of certain medications from coverage under the plan. Select Formulary does not allow for grandfathering of existing utilizers. Administrative Fees Per Paid Claim $9.75 Monthly Minimum $

5 Claims Repricing / Evaluation Summary