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PCA Powerpoint Overview


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PCA RX Company Overview

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PCA Powerpoint Overview

  1. 1. Company Overview
  2. 2.  Prescription Corporation of America (PCA) is a rapidly growing Pharmacy Benefit Manager (PBM) located in Denville, New Jersey. Since launching operations in January 2011, we have added over 80 private and public sector clients. PCA has created a pharmaceutical pricing, delivery and systems model that benefits plan sponsors and patients, rather than prescription drug program administrators. 2
  3. 3. PCA’s mission is to reduce and control prescription drug costs for our clients,while improving the quality of care for the members and families we serve. 3
  4. 4.  Retail Pharmacy Prescriptions Mail Order Home Delivery Service Patient Empowerment Program (PEP) Prescription Discount Cards Non-Profit Drug Programs 4
  5. 5. Service Highlights – How PCA accomplishes its mission Expert benefit management, plan design, and cost control Efficient retail claims processing within our nationwide network of 64,000+ pharmacies Ability to guarantee claim rates through reinsurance 24/7/365 Customer Service where you speak to a real live person who has a personalized focus on your members and their families Mail Order Home Delivery Service from our Denville, NJ pharmacy Patient advocacy and education Business model firmly based on transparency and proactive benefit cost management 5
  6. 6. PCA administers plans for many types of clients: Commercial clients including employer groups of varying sizes in a broad range of industries Business associations, chamber of commerce organizations, and trade groups All levels of government entities (towns, counties, and school boards) Labor groups, unions, welfare funds, and Taft Hartley plans Charitable organizations and other qualified non-profits with over 23,000 union members 6
  7. 7. PCA Programs Self Insured – our relationship with reinsurers allows us to offer guaranteed claim rates, along with full transparency and 100% return of manufacturers’ rebates. Fixed Cost – access to reinsurance enables us to offer the most effective fixed cost, capitated, fully funded plans. Rx $avings $olutions – these affordable plans feature generic only or generic and preferred brand formularies, allowing us to provide lower cost alternatives than our competitors. PCA Prescription Savings Card – this program enables members and their families to realize savings of 15% to 75% on prescription drug purchases through a nationwide network of over 62,000 pharmacies. Patient Empowerment Program (PEP) this voluntary clinical management – program provides members with a CASH incentive to try brand-to-generic substitutions and therapeutic brand alternatives. PCA Non-Profit Drug Program – allows non-profits to purchase medications at the lower cost hospital acute care “Class of Trade” rate.____________________________________________________________________________________________________________________________________________These programs are complimented by our formulary management, clinical programs (includingMedication Therapy Management (MTM) and Step Therapy), 24/7/365 live customer service, andconsultative services focused on opportunities to maximize savings. 7
  8. 8. Our Competitive Advantages While PCA’s growth allows us to leverage major alliances andrelationships with pharmaceutical manufacturers, we remain focused on personalized customer service for our clients and members. ____________________________________________________________________________________________________________________________________________ Lower Program Costs - As a true client advocate, PCA’s programs, plan designs, and pricing achieve the lowest drug program costs without sacrificing quality of care. Reinsurance – Our alliance with reinsurance providers allows us to guarantee savings, or administer effective fixed cost plans. Consultative and Administrative Services – PCA will help you select your formulary and plan design from our many options. Our analytic and reporting tools, combined with our expert analysis, will maximize your savings opportunities. Our Pharmacy Network – PCA’s network features over 64,000 pharmacies nationwide. We also have a Preferred Network option with over 20,000 pharmacies allowing for deeper discounts. Claims Processing - Our partnership with Argus Health Services provides state-of-the-art electronic claims adjudication capabilities. Argus currently processes over 500 million pharmacy claims a year. 8
  9. 9. Mail Order Home DeliveryPCA’s Mail Order Home Delivery Pharmacy is located at our Denville, NJ headquarters and designed to take advantage of the lowest purchasing prices available, allowing us to pass along these savings to our clients and members. Unlike other PBMs that have outsourced mail orderarrangements, PCA’s pharmacy facility is operated by our in- house pharmacy team. Your plan members can access allthe details of this program andget started through our website at 9
  10. 10. Customer Service PCA’s multi-lingual, 24/7/365live customer service capabilities for providers and members feature personalized servicetailored to your plan design. Wedeliver "real-time" access to plan information and out-of-pocket expenses, as well as clinical information on the proper utilization of medications. 10
  11. 11. PCA continues to develop our user- friendly website,, with the latest information on our programs and formularies, our Mail Order HomeDelivery Program, a pharmacy locator, the ability to price and compare medication costs, clinical programs,and updates on new PCA initiatives. 11
  13. 13. Here are a few examples of recent results: Regional High School with 500 employees: 11% savings based on insured renewal of fixed-cost program with 12 month rate guarantee. New Jersey County with 3,400 employees: $546,000 in guaranteed savings for self funded program based on hard-dollar claim cost reduction. Non-Profit Association with 33,000 members: 18-55% savings on prescription purchases with discount savings card provided free of charge to all members. 13
  14. 14. PCA Savings Illustration Regional High School with 500 employees: Fixed-cost program with twelve-month rate guarantee and 9.88% savings based on insured renewal. Enrollment Incumbent PCA Annual Annual Rates Premium Rates Premium Single $134.28 $273,931 $121.02 $246,881 Parent & Child(ren) $288.12 $107,181 $259.66 $96,594 Two Adults $319.94 $345,535 $288.34 $311,407 Family $385.92 $879,898 $347.81 $793,007 Dependents Age 26 – 31 $81.64 $16,655 $73.58 $15,010 Annual Fixed Cost $1,623,199 $1,462,899 Percentage Savings 9.88% Total Dollar Savings $160,301 14
  15. 15. Basic SurveyHere are the initial questions we ask: How much does your Rx Benefit Plan cost per year? Is it part of your medical plan or administered separately? Is it self funded or does it have monthly fixed rates? May we develop a formal proposal with guaranteed savings? 15
  16. 16. Benefit Equivalency Same Plan Design No Change of  CoPay  Covered Medications  Exclusions Benefit Equivalency Letter 16
  17. 17. PCA Prescription Savings Cards Sample Cards 17