Pre-Authorization, Competitive Bidding and Manufacturers’ Discount-Based, Specialty Pharma Purchasing and Access Program that Produces Significant Savings.

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Presentation transcript:

Pre-Authorization, Competitive Bidding and Manufacturers’ Discount-Based, Specialty Pharma Purchasing and Access Program that Produces Significant Savings HR Specialty Products & Services Catalogue Executive Summary A No Frills Distillation of Vendor’s Marketing Collateral Thomas A Ference President & CEO Human Resources Mining & Distribution Co Locating, Validating and Accelerating HR  Innovation   Office: 219-662-0201 Cell: 630-240-2583 Fax: 219-661-0236 e-mail: tference@hrmdco.com Website: www.hrmdco.com

Specialty Pharma Management Program Specialty Meds are projected to account for 50% of an employer’s Rx spend by 2020 . The “Big Three PBM” oligopoly controls 76% of all prescriptions effectively locking many employers into the controlled market Creative ways must  be found and in fact, have been found to take out the sting. This specialized Rx consultancy uses proprietary techniques to validate the need for and then source specialty pharmaceuticals to dramatically reduce spend employer and employee spend  

Specialty Pharma Management Program The process begins with a team of non-PBM-affiliated (thus, financially objective)  doctors and pharmacists who provide an independent, unbiased Prior Authorization to ensure that the medications being prescribed are clinically appropriate. If found to be so, the vendor shops over a dozen of the nation’s most competitive Specialty Pharmacies that bid for the business. Other techniques include  re-designing the Rx benefit plan to allow employees to qualify for manufacturers assistance. In qualifying, Prescription Advocates work closely with members to complete and submit initial and ongoing paperwork .

Specialty Pharma Management Program Results have been a 70-80% employer savings on select Rxs and a $0 Rx plan member co-pay for specialty meds at the employer’s option. Vendor is compensated on a contingency basis in the from of a percent of savings NOTE: This summary was constructed by HR Mining based on source materials provided by and preliminary discussions with the vendor. The vendor has not yet reviewed this summary material. Clarifications and verifications can be had in discussions with the vendor which HR Mining will arrange for.

Case Study 128 ees on Specialty Rx Medication Name Dosage Quantity Day Supply PBM Cost Our Cost Savings Janumet 50/100 MG 180 90 $ 1,116.06 $ 300.00 $ 816.06 Promacta Tab 50 MG $ 21,534.66 $ ‐ Eliquis 5 MG $ 1,024.77 $ 463.68 $ 561.09 Enbrel Inj 12 $ 12,558.00 $ 12,258.00 $ 287.28 $ 828.78 Advair Diskus 250 MCG $ 927.60 $ 275.28 $ 652.32 Breo Ellipta 100/25 MCG $ 750.00 $ 280.68 $ 469.32 250MCG $ 234.90 $ 692.70 Spiriva 18MCG $ 631.17 $ 243.90 $ 200,444.04 $ 7,681.44 $ 193,006.50 Annual Savings 96.29%

Next Steps This product/service is contained in the HR Specialty Products & Services Catalogue™ Operational level details about this particular service provider can be obtained in conference with the vendor The HR Mining &Distribution Co. is an independent and contracted representative of the vendor Upon your request, we will arrange for an introduction that can range from a simple, quick conference call to a services overview / system demo Tom Ference 219-662-0201 (Chicagoland area) or tference@hrmdco.com Thank you for your potential interest in this fresh thinking