CAP Rx Discount Card Presentation

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This presentation provides a comprehensive explanation of the Community Assistance Program (CAP) and the outreach effort behind the Rx discount card to help the un-insured and under-insured fill their medications more affordably at their local pharmacies.

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CAP Rx Discount Card Presentation

  1. 1. SavingsCommunity Assistance Program Making healthcare more affordable A free resource to help your un-insured and under-insured patients save money on their prescription medications. 1-866-889-1662 www.USMedSavings.org info@usmedsavings.org www.facebook.com/communityassistanceprogram
  2. 2. Topics explained in this Slide Presentation: Explanation of an Rx savings card - Slides 3 & 4 How discounts are created on Rx at local pharmacies - Slides 5 - 9 Explanation of the Community Assistant Program (CAP) outreach effort - Slides 10 & 11 Commonly asked questions - Slides 12 - 26 Additional Tools: How to use the Pharmacy & Rx pricing lookup tools - Slides 27 - 34 Languages available for the Rx savings card - Slide 35 Other resources provided through CAP: Rx Med Assist (a Prescription Assistance Program) - Slides 37 & 38 CAP Diabetic Program (diabetic testing supplies) - Slides 39 - 40 Contact information - Slide 41
  3. 3. What is a Prescription Drug Discount Card? A resource for people who are under-insured or un-insured to help them save on their prescription medications at their local pharmacy. A resource designed to provide quick and easy access to more affordable prescription drug pricing.
  4. 4. How are the Discounts Established With an Rx Savings Card?  The vast majority of pharmacies nationwide contract with Pharmacy Benefit Mangers (PBMs) to establish pricing structures on medications for health care plans.  For non-insurance Rx savings cards, discounted pricing for name-brand and generic medications are established in this same way to help un-insured and under-insured consumers more affordably fill their medications. Pharmacies benefit from this collaboration through increased store foot traffic, enhanced customer loyalty and added sales of pharmacy & non-pharmacy goods and services. A few things to know…  Roughly 70% of the three billion prescriptions filled each year in the US are handled through Pharmacy Benefit Managers (PBMs).*  PBMs handle pharmacy benefits for nearly 200 million Americans including 65% of the country’s seniors.** Source: Report to the FTC; ―PBMs: The Basics and an Industry Overview‖ – The Health Strategies Consultancy, LLC 2003
  5. 5. Pharmacy Benefit Manager (PBM) Relationships Pharma Manufacturer Figure 1 This diagram (Figure 1)illustrates the variousconnections PBMs have Retail Pharmacies PBM Employer/ Plan Sponsorthroughout the health careindustry. Health Plan/ Insurance Company Source: Report to the FTC; ―PBMs: The Basics and an Industry Overview‖ – The Health Strategies Consultancy, LLC 2003
  6. 6. HealthTrans® , a Leading PBM Allowing Access to Rx Savings Card Discounts Pharma One of the largest, most established Manufacturer PBMs is HealthTrans®. (see Figure 2) HealthTrans has an A+ rating with the Better Business Bureau. Retail Employer/ HealthTrans® HealthTrans® is the PBM for the Pharmacies (PBM) Plan Sponsor discount Rx savings cards we mail to you as a part of a grassroots outreach effort (Community Assistance Program (CAP)) to help people who are un-insured and under-insured. Health Plan/ Insurance Company Figure 2. illustrates HealthTrans’ relationship to the CAP grassroots outreach effort to help people receive discounts on their Rx meds.
  7. 7. HealthTrans® (PBM), Pharmacies, and the Discount RxSavings Card Provided Through the CAP Outreach Effort Pharma Manufacturer Figure 3 illustrates the relationship between HealthTrans® Figure 3 and retail pharmacies to show how they relate to the CAP outreach effort. Retail HealthTrans® Employer/ (PBM) Plan Sponsor The CAP outreach effort provides Pharmacies the discount Rx savings cards to health care organizations* who are on the front-lines of helping people who are un-insured and Individual Health Plan/ under-insured. with Rx card to Insurance Company fill prescription * hospitals, clinics, emergencydepartments, urgent care facilities,mental health organizations, andcommunity non-profits. Outreach Effort- Providing this resource to hospitals, clinics, non- profit orgs., etc. Source: Report to the FTC; ―PBMs: The Basics and an Industry Overview‖ – The Health Strategies Consultancy, LLC 2003
  8. 8. In the Beginning… Affordable Access Health Care Organizations (AAHCO) have long existed to offer an affordable alternative to insurance. AAHCOs network with doctors and dentists to establish non-insurance reduced fee-for-service plans. These plans are less costly than traditional insurance (but less comprehensive) and can offer a viable solution to the un-insured and under-insured who are challenged with obtaining or affording traditional insurance coverage. Affordable Access Health Care Organizations (Discount fee-for-service plansDiscount medical for un-insured & under-insured) Discount dental plans with plans with discount discount Rx medications Rx medications
  9. 9. A Helpful Resource During Good Times and Bad  With the economic downturn, the need for assistance rose significantly for people who lost their employer-sponsored health coverage when they were laid off or couldn’t find employment. Private coverage was often too expensive and many employers reduced or eliminated employee health coverage due to rising premiums, etc.  A few of the AAHCOs realized that the prescription savings resource they provide to their fee-for-service plan clients could easily be made available, without cost, to people who were un-insured and under-insured—independently of the medical or dental reduced fee-for- service plans.  Since offering the Rx savings card resource for free didn’t require added cost to the AAHCOs, nor any paperwork, enrollment or qualifications on the part of the card holder, it made sense to make this prescription resource available, at no cost, to people who are un- insured and under-insured. This inspired the establishment of the Community Assistance Program, a collaborative grassroots outreach effort to help people access their medications more affordably. Affordable Access Discount dental Community Assistance & medical Discount Program:Health Care Organizations Outreach effort providing plans with Rx Medications this resource to(Discount fee-for-service plansfor uninsured & under-insured) discount (Free Rx savings card) hospitals, clinics, non-profit orgs., etc. Rx medications Figure 4. illustrates the evolution of the Rx savings card and outreach effort.
  10. 10. What is the “Community Assistance Program”? Community Assistance Program (CAP) is the name of the grassroots outreach effort to provide the Rx discount resource to hospitals, clinics and other health care-related groups. This outreach effort grew it’s legs at the beginning of the economic downturn with the specific intention of offering these prescription savings cards to medical professionals on the front-lines of helping people in need including:  Case Managers  Social Workers  Clinics  Emergency Department  Mental Health Facilities  Non-profit Organizations Rx
  11. 11. Community Assistance Program (CAP) Further Explained  CAP is a collaborative effort between various groups dedicated to affordable access to healthcare.  Because CAP collaborators already offer the HealthTrans® Rx savings card to their medical and dental reduced fee-for-service clients, there is no additional cost—other than postage—for them to provide this helpful prescription resource to your organization.  CAP is a way for these healthcare access groups to lend their support to people who are un-insured and under-insured.  Providing the HealthTrans® Rx savings card resource to the people you serve does not promote or endorse any of the organizations involved in this grassroots outreach effort.
  12. 12. Commonly Asked QuestionsRelated to CAP, the Rx savings Card, and HealthTrans®
  13. 13. Q: Is the Community Assistance Program a ―program‖that we have to enroll in? Are we required to do anythingwhen we receive the Rx savings cards?A: There are no enrollment requirements in order torecieve, utilize, and benefit from the Rx savings cards. Community Assistance Program is just the name of the outreach effort. It is not a formal ―program‖ that requires sign-ups, qualifications, or paperwork. This applies to both the organization receiving the cards and the individual card user. The Rx savings cards are ready for immediate use at most pharmacies nationwide. An organization such as a hospital or clinic receiving the cards are not required to do anything when distributing the resource. Although we hope you take advantage of this valuable resource, it’s purely voluntary for you to provide the Rx savings cards to people in need.
  14. 14. Q: Should we be aware of any promotion or endorsement of a vendor, company or pharmacy when providing these Rx savings cards to the community we serve? A: With this Rx savings card there is no promotion or endorsement of any organization, company or pharmacy when providing it to those in need. Note the HealthTrans logo on the front of the CAP Rx savings card: This logo is needed to assist the pharmacy so they know what appropriate discount to apply. As noted on previous slides, HealthTrans® is the pharmacy benefit manager for the Rx savings cards used in this outreach effort. HealthTrans® has a solid reputation, with the highest rating with the BBB* and an extensive network of pharmacies that they are contracted with. This enables them to establish discounts on meds that are higher than average drug pricing discounts. * www.bbb.org/denver/business-reviews/health-care-management/healthtrans-in-greenwood-village-co-90020054
  15. 15. Q: Who are you providing these Rx savings cards to as a part of the CAP outreach effort?A: There many types of organizations that have expressed the need for the Rx savings card to help those they serve. These include:  Hospitals  Community Centers  Clinics  Religious Groups  PCPs  Weight Loss Clinics  Mental Health Facilities  Assisted Living FacilitiesHere’s a list of a few organizations actively providing the CAP Rx discount card totheir patients:• The USDA • Bright Star Missionary Baptist Church• InsureEasyLife.com • Forgotten Harvest• LUPE • Bayada Nurses Home Care Specialists• General Federation of Women’s Clubs • All Medical Resource Foundation, I• New Jersey Chamber of Commerce • International Technologies Medical Lab Svcs.• C.A.L.I.F. (Community Actively Living Independent & Free)
  16. 16. Q: What kind of savings do people experience when they use the CAP/HealthTrans® Rx savings card?A: When someone with a valid prescription presents the HealthTrans® Rx savings card at a participating pharmacy, they can save on average: 15% on Brand Name Drugs 55% on Generic Drugs  Savings range from 10% to 85% off all prescription drugs.  The card can be used over and over again and it never expires. Note: Privacy of card user is protected and no personal information is gathered at time of use.
  17. 17. Q: Is there a cost to get this resource for our organization? A: There is no cost to receive the CAP Rx savings cards. Through a grassroots outreach effort called Community Assistance Program, we have the ability to provide this resource to your organization for free.
  18. 18. Q: After we run out of our first batch of Rx savingscards, can we continue to request more from you?A: Absolutely! Our goal is to provide this resource to any organization that has a need for it on an ongoing basis. Feel free to request additional Rx savings cards at any time. Other translations of the Rx savings cards are available. (see slide #32)
  19. 19. Q: What prescription drugs can a person get discountson using the Rx Savings Card?A: All FDA approved prescription drugs are eligiblefor a discount with the Rx savings cards—name-brand and generic. Smoking cessation meds, psychotropic meds and diabetes supplies can also be obtained at greatly reduced rates.
  20. 20. Q: Does it cost a card holder anything to use the Rx savingscard at a pharmacy and receive discounts on prescriptionmedications? A: The Rx savings card is free to use at any participating pharmacy.  The card user is responsible for paying the discounted price of the prescription medication(s) once the card has been presented. Note: Multiple medications can be filled at the same time using one Rx savings card and it can be used over and over without expiration.
  21. 21. Q: Is the number of pharmacies that accept theRx savings card limited?A: Not at all. Over 80% of pharmacies nationwide andUS territories accept the HealthTrans® Rx savings card. Many well-known pharmacies that participate are: CVS • Walgreens • Rite-Aid • Wal-Mart • Target • Kroger K-Mart • Longs Drugs • Safeway • Osco • Sav-On • Ongs Albertsons Sam’s • Winn-Dixie • Costco • Brooks • Stop & Shop • Medicine Shoppe Duane-Reade • Heb • Meijer • Hy-Vee • Giant • Raleys • Shopko • Bi-Lo Smiths • Pathmark Fred Meyer • Aurora • Pamida • Frys • Kings ShopRite • Hannaford • Tops • Weiss • and many more... * Many local independent pharmacies accept the card too. Simply go to: www.USMedSavings.org to find a participating pharmacy in your area.
  22. 22. Q: Is there any paperwork or pre-qualifications in order for someone to use the Rx savings card? A: Absolutely None The Rx savings card is a ―bearer card‖ meaning anyonepresenting the card at a participating pharmacy can receive asavings. Additionally, there is no gathering of any personalinformation at time of use—not even the person’s name.
  23. 23. Q: Will a discount be given every time the Rx savings card is used? A: A person using the card will get a discount approximately 94% of the time.  The reason it is not 100% of the time is that, from time to time, pharmacies price certain drugs at ―cost‖ to attract customers to their stores. In this type of situation the cardholder would get the lowest price.Average Savings: 15% on Brand Name and 55% on Generics.
  24. 24. Q: How will the Rx savings card holder know if they’re getting a discount? A: An Rx savings card user can go to www.USMedSavings.org and look up what the price of their drug is at their local pharmacy. (see slide #27 of this presentation) -or- The Rx savings card user can ask the pharmacist at the time of purchase how much of a discount they received using the card.An entire household can use one Rx savings card. The card can be used over and over again & does not expire.
  25. 25. Q: Can the HealthTrans®/CAP Rx savings card be used with insurance? A: Yes and No. If someone has Rx insurance, but their medication falls outside of what’s covered by their Rx insurance formulary, then the Rx savings can be used. However, it cannot be used to receive a discount on an insurance co-pay.Here are some situations where the card can be used alongside Insurance:  Limited Formularies – Insurance companies are increasingly limiting which drugs they will pay for. The Rx savings card can be used to receive a discount when a medication is not covered. For example: birth control, diabetic supplies, smoking cessation, and other types of drugs that the insurance company decides are not cost effective for them.  High deductible plans – The Rx savings card can help people reduce the cost of their Rx meds while they are within their plan’s deductible limit and are required to pay 100% out-of-pocket for their prescriptions.
  26. 26. Q: Can someone use the Rx savings card even if they have Medicare or Medicaid (Medi-Cal)?A: Yes, the Rx card can be used alongside these plans. For example:  Medicare – The Rx card can be used when someone has Medicare, but is not enrolled in the Part D prescription coverage plan.  Medicare Part D – The Rx savings card can be used to secure discounts on those drugs that are excluded from Medicare Part D. It will also provide discounts when a person on Medicare reaches the ―donut hole coverage gap‖. Excluded coverage for medications treating certain conditions under Medicare Part D: Anorexia, weight loss, weight gain, fertility, hair growth, supplemental relief of cough, Rx vitamins, and sleep aids.  Medicaid and Medi-Cal – The Rx card can be used when a medication falls outside of the set formulary under these programs. An increasing number of people are experiencing this problem due to recent cutbacks in these programs at the state level.
  27. 27. Additional tools to help your patients
  28. 28. To locate pharmacies that accept the Rx Savings Card, follow these steps:1. www.USMedSavings.org (Must type into address bar at top of screen)2. Click on the Drug Pricing & Pharmacy Look Up link button on the Home Page.3. Click on Pharmacy Locator as shown here: You will come to a web site similar to the image below… (Chose “By Distance…” or “By Pharmacy” then enter city, state, zip code and distance of the pharmacies you wish to search as shown below and click the “Go” button)   (Go to following slide for search results)
  29. 29. Search results of pharmacies that accept the Rx savings card within a specific city.
  30. 30. To price the discounts on medications using the Rx savings card, follow these steps:1. www.USMedSavings.org (Must type into address bar at top of screen)2. Click on the Drug Pricing & Pharmacy Look Up link button on the Home Page.3. Click on Rx Drug Pricing as shown here: You will come to a website similar to the image below… (Enter the name of the medication in the “Drug Name” box as shown below and click the “Go” button)  (Go to following slide for search results)
  31. 31. Pricing the discounts on medications using the Rx savings card, continued… 1. Click the circle left of on Rx dosage you wish to price (see ).  (See following slide for additional steps)
  32. 32. 2. After choosing Rx dosage wait a few seconds for the script details to appear as shown below and enter info.   3. Click the ―Price Drug‖ box to price the prescription med. (See following slide for pricing results)
  33. 33. Example, here are the pricing results for name-brand Zocor and its generic version, Simvastatin using the HealthTrans®/CAP Rx savings card at Walgreens Pharmacy in the 78205 zip code:  
  34. 34. Here are pricing results for name-brand Zocor and its genericversion, Simvastatin using the HealthTrans®/CAP Rx savings card at various pharmacies in the 78205 zip code: CVS Pharmacy 343 W Houston St Zocor 40 Mg Tablet 30 tablets: $164.68 San Antonio, TX Simvastatin 40 Mg Tablet 30 tablets: $53.20 Trinity Rx #3 700 S Saint Marys St Zocor 40 Mg Tablet 30 tablets: $164.74 San Antonio, TX Simvastatin 40 Mg Tablet 30 tablets: $10.86 M and S Tower Pharmacy 730 N Main Ave Zocor 40 Mg Tablet 30 tablets: $165.93 San Antonio, TX Simvastatin 40 Mg Tablet 30 tablets: $11.36 NOTE: This price comparison is not an endorsement of one pharmacy over another, it’s just an example of how the Rx Pricing tool can really help your patients save even more. We appreciate how busy you are. These are just tools that you can use at your discretion.
  35. 35. The Rx savings cards can be translated in other languages!Arabic • Armenian • Farsi • Hmong • Khmer • Korean • Mandarin • Russian • Somali • Spanish • Tagalog • Vietnamese
  36. 36. Q: Are there other resources available through CAP?A: There are TWO supplemental programs available:1) A prescription assistance program called Rx Med Assist that can reduce the price of expensive prescription medications.2) CAP Diabetic Program to reduce the cost of testing supplies for diabetics.
  37. 37. What is Rx Med Assist? Rx Med Assist is a Prescription Assistance Program (PAP). PAPs date back to the 1950s when the U.S. government created incentives for pharmaceutical companies to help uninsured and under-insured Americans receive low-cost or free prescription drugs. While PAPs are run by pharmaceutical companies, without a resource like Rx Med Assist, the enrollment process can be complicated and overwhelming to patients. Rx Med Assist simplifies the enrollment process for people who have no public or private prescription drug coverage and struggle to pay for their monthly maintenance medications How does Rx Med Assist help patients? Informs and educates patients about the  Handles all annual reapplications for the options that best fit their needs. patient. Accesses, completes and processes all  If patient is eligible, the cost of each required forms. qualifying medication is reduced to $20 per month. Reviews over 250 programs that may help the patient save on their prescription meds.
  38. 38. What guidelines must be met in order to quality for Rx Med Assist? Medication must be offered through a Annual Income Eligibility Guidelines for 2012: Prescription Assistance Program (PAP). Family Size Annual Gross Family Income Limits Income eligibility guidelines apply 1 $27,225 depending on total family members (see 2 $36,775 chart). 3 $46,325 4 $55,875 5 $65,425 Applicant cannot be covered by private 6 $74,975 prescription coverage, Medicare Part- 7 $84,525 D, or Medicaid (Medi-Cal). (some 8 $94,075 exceptions may apply) For each additional $9,350 family member Please call us at 866-889-1662 to learn more about the program - or - visit www.usmedassist.org for additional information or to submit an application.
  39. 39. What is the CAP Diabetic Program?CAP Diabetic Program is a supplemental resource provided through theCommunity Assistance Program (CAP) for discounted diabetic testingsupplies (mail-order) for the uninsured and under-insured.The savings through the program average 50% off retail, over-the-counterpricing of diabetic testing supplies received through mail-order.Monthly retail pricing for test strips: The program includes the following: • $29.99 test once daily  Free glucose meter • $41.99 test 2 times daily  Free lancing device • $43.99 test 3 times daily  Free monthly ultra-thin lancets • $56.99 test 4 times daily  Free carrying case • $58.99 test 5 times daily  Free monthly shipping • $69.99 test 6 times daily  Free Rx discounts (provided • $78.99 test 7 times daily through the CAP Rx savings card) • $86.99 test 8 times daily • $94.99 test 9 times daily
  40. 40. How do you enroll in the CAP Diabetic Program?There are three easy ways to enroll:1. Complete the easy online form at www.CAPDiabeticProgram.org and submit it electronically.2. Call 1-888-983-7829 & mention group ID 1117 to speak with a friendly customer representative who will assist you with enrollment.3. Go to www.CAPDiabeticProgram.org and print an enrollment form to fax or mail in. Frequently asked questions:How does the program work?Upon enrollment, you will be electronically debited monthly from your checking accountor credit card for everything you need to test your blood glucose levels monthly. Supplieswill be shipped right to your door.Are there any upfront fees, cancellation fees or long-term contracts?No, the program is month-to-month and you can cancel at any time without penalty. Call us if you have any questions about this program: 866-889-1662
  41. 41. Community Assistance Program Making healthcare more affordable Please call or email us if you have any questions orif you would like to receive a free supply of Rx savings cards for your organization. 1-866-889-1662 www.USMedSavings.org info@usmedsavings.org www.facebook.com/communityassistanceprogram

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