Presenting The Alpha Group s

Transcription

1 Presenting The Alpha Group s

2 What is the $30 Pharmacy Program? A Pharmacy Advocate Program working directly with over 180 U.S. based pharmaceutical manufacturers Not a discount card or insurance program Set monthly price of $30 per month per medication Formulary of over 1,500 prescription medications Includes the top 100 prescribed medications in America Manages medication for clients throughout the year 1

3 How Do You Qualify for the Pharmacy Program? Medication benefit and program eligibility based on household size and income, general parameters are: Up to $30,000 per year for an individual Up to $50,000 per year for a couple Guidelines increase with each additional member in household earning up to $100,000 per year 2

4 How Does the Pharmacy Program Work? View Pharmacy Program information online Enrollment form to be completed online - includes: Personal information Medication list Healthcare provider s name(s) Payment information Pharmacy Program coordinates with enrollees, their healthcare providers and the pharmaceutical companies All medications are FDA-approved and supplied by U.S.-based manufacturers Medication is delivered by mail in 90-day quantities with The enrollee s payments of $30 per month per medication are designed to keep cost low and consistent 3

5 What are some Covered Medications? Abilify Effexor Lyrica Suboxone Advair Diskus 250/50 Enbrel Nexium Symbicort Celebrex Flexeril NovoLog Topamax Chantix Flovent HFA Pradaxa Vesicare Cialis Humalog Kwiken Premarin Viagra Crestor Humira Prozac Victoza 3 Pak Cymbalta Januvia Risperdal Vytorin Diovan Lantus / Lantus (SoloStar pen) Spiriva Handihaler Over 1500 medications are included; List subject to change Xarelto 4

6 What Happens at Enrollment? Step 1 Enroll through the link provided Step 2 Pharmacy Program will: Initiate a Welcome Call to enrollee and mail information about the Pharmacy Program Correspond with enrollee to verify income Coordinate with enrollee s doctor(s) regarding medication and obtaining prescription Provide contact information for questions and concerns 5

7 What Happens at Enrollment? (Cont.) Step 3 Once income is verified and doctor information is received, prescription is filled by manufacture, refills will be handled automatically Note: Steps 2 & 3 can take up to 4-6 weeks to receive the first 90-day supply of medication First $30 payment happens when Step 2 begins Subsequent $30 payment deductions happen on the 5 th day of the following month 6

8 What does the Pharmacy Program Cost? $30 per month per medication No enrollment or application fees No tiers, co-pays or deductibles No other costs, fees or charges associated with prescription medication or pharmacy services 7

9 Who Benefits from this Pharmacy Program? Individuals on high deductible plans Employees with high deductibles People without insurance coverage who take medication Individuals with a Health Share plan Employers with lower income employees on high priced medication (potential for reduced claims associated with the group health plan) 8

10 Why use this Pharmacy Program? Set price of $30 per medication per month No age limit No risk to enrollee Not a discount card Not an insurance plan Used as a supplement to existing insurance coverage 9

11 Additional Details Once determined that the Pharmacy Program can assist, the first payment is debited, allowing the Pharmacy Program to work with the enrollee After the initial payment is received, the monthly debit occurs on the 5 th of each month Payment methods: Debit or Credit Card with Visa, MasterCard, Discover or American Express logos 10

12 Additional Details Cont. Medication typically delivered in 90-day supplies First delivery of medication typically arrives within 4-6 weeks from receipt of completed paperwork from the enrollee and their healthcare provider Refills arrive on set schedule so there is no lapse in ongoing therapy 11

13 Employer Interaction If they choose, an employer can pay the set price for medications on behalf of the qualifying employee Possibly provides cost savings for both employer and employee Suggestion: Offer the Pharmacy Program to all eligible employees (both current and new hires) to ensure that all have the opportunity to benefit from the program This Pharmacy Program is NOT an insurance product and does NOT impact the actuarial value and health plan discrimination rules 12

14 Next Steps Use the below link/website address to enroll in the Pharmacy Program *** You can share with friends, family, acquaintances anyone Link/Web Address: All fields on the enrollment form must be completed, including the payment information, before the form will be processed and the enrollee contacted by a Pharmacy Advocate 13