In the fall of 2022, ProxsysRx set-out to extend its pharmacy-based services to hospitals, their affiliated physicians and their patients by offering a multi-benefit prescription savings card. One that helps make unaffordable drugs more affordable, while increasing patients’ access to medications through prescription discounts. Just as importantly, a card that gives participating health systems access to prescription-fulfillment data that’s commonly lost when patients use other prescription-savings cards.
The growing problem of prescription non-adherence
According to a study published in the Annals of Internal Medicine, nearly 1/3 of all prescriptions are never filled by patients, and up to half of medications for chronic conditions like diabetes and hypertension are never taken. This often leads to adverse healthcare outcomes downstream, and it’s a problem across the demographic spectrum of healthcare consumers — from uninsured and Medicare-patients to fully-insured. The cost of prescription non-adherence to the community at large — which ultimately pays for uncompensated care (particularly for hospital readmissions) — is staggering.
The growing problem of insured prescription drug pricing
According to a 2018 study conducted by the University of Southern California Schaeffer Center for Health Policy & Economics and reported by Kaiser Health News, 23% of the time, patients pay more for their prescriptions using their insurance coverage copay than they would have if they’d simply paid the cash price for their prescriptions. Think about that: If you’re covered by health insurance, nearly 1 in 4 of your prescriptions may cost you less paying for them out-of-pocket than by using your insurance and paying the deductible. Possibly even more, if you’re taking full advantage of available prescription discounts.
As the study’s authors noted, “Overpayments are more likely on claims for generic versus brand drugs (28% vs. 6%), but the average size of the overpayment on generic claims is smaller ($7.32 vs. $13.46). In 2013, total overpayments amounted to $135 million in our sample, or $10.51 per covered life.”
The study also reported that “on some prescription claims, the total cost of the drug is less than the patient’s copayment, and the insurer or pharmacy benefit manager (PBM) keeps the difference in what is known as a ‘clawback.’ Some pharmacists have expressed frustration that they are bound by ‘gag clauses’ in their contracts with insurers and PBMs not to disclose to patients when they could save money by not using their insurance because of such practices.”
Consider this cost-plus drug company model
A recently-launched company uses a Cash Pay business model to sell the generic drugs they manufacturer, offering end users prescription discounts based on their costs (plus a 15% markup and a pharmacy-labor fee) for all prescriptions filled through them. It’s an absolutely sound business model for a tremendous amount of prescriptions, at least where out-of-pocket costs to patients is concerned.
The problem with the business model is that, when patients use the company’s prescription discounting services, or other well-known discount cards, their transactions are never reported back to the physicians who wrote those prescriptions, or to the health systems where they work. Not only is this bad for patients, who lose the potential follow-up support their providers often offer as part of their ongoing care for them, it’s bad for providers whose Value-Based Care scores are determined (in part) by patient-prescription adherence.
Let’s consider the example of a patient on Medicare Advantage, prescribed a medication to treat their cholesterol problem: If the patient pays for his or her prescription through one of those discounters, that information is not reported back to Medicare Advantage plans. The insurer considers that prescription unfilled, and the physician is penalized through lower Value-Based Care scores.
MedServRx can solve both problems: Cost and reporting
PBMs working with insurance providers use the Average Wholesale Price (AWP) to determine their prescription prices. That’s the highest-price standard you can use for determining prices.
MedServRx offers patients of participating health systems prescription-discount savings of up to 80%, and ProxsysRx pharmacies use the National Average Drug Acquisition Cost (NADAC) for its prescription pricing. Jointly developed by the Centers for Medicare and Medicaid Services (CMS), NADAC pricing is what most Medicare / Medicaid recipients pay — and is significantly lower than AWP pricing. For non-ProxsysRx pharmacies, MedServRx draws-on multiple prescription discount networks to find the lowest price — whereas the most common drug discount cards draw-on a single network.
What’s more, all MedServRx-filled prescriptions come with the added benefit of the same prescription-fulfillment reporting their providers get when patients use their insurance coverage to fill prescriptions. Their prescription data is captured and shared with Medicare payers and patients’ healthcare providers, thus ensuring accurate reporting of health systems’ patient-adherence — while giving providers a clearer picture of their patients’ progress. This prescription data sharing improves the patient experience, by lowering their costs and by ensuring a higher likelihood of appropriate follow-up care from their physicians.
These detailed utilization reports can validate gap closures for patients filling prescriptions “off plan.” What’s more, MedServRx provides activity reports at all levels. By drug, prescriber, patient, etc. Finally, MedServRx delivers Community Savings reports as part of its service to participating health systems. These reports detail savings created for the community by the hospital-sponsored prescription discount plan.
Health systems operating on thin or negative annual profit margins can present prescription-fulfillment data reported by MedServRx to insurers, which can help improve their value-based performance scores — and thus improve their reimbursement. This additional reimbursement revenue can be used by those health systems to support community outreach services they wouldn’t otherwise be able to offer patients in their area.
Additional MedServRx advantages for patients and health systems
MedServRx’s prescription discounts are available to all patients of its participating health systems, and at all local pharmacies in those health systems’ areas. No accounts or insurance cards are required. Patients’ prescription discount cards activate automatically when they use them for the first time, and patients continue saving whenever they use their cards to fill prescriptions.
What’s more, patients don’t even need to carry printed MedServRx cards to enjoy the prescription discounts they provide. Each participating health system has a unique MedServRx.com website address (IE: The MedServRx address for Greenville, Texas’s Hunt Regional Healthcare is medservrx.com/hunt). There, patients will find a digital card they can present at any local pharmacy whenever they fill a prescription.
MedServRx’s advanced prescription price-comparison search capabilities
MedServRx leverages its contracting power — and its access to numerous drug-discounting networks — to offer prescription prices among the lowest in any given market. Patients with insurance coverage can use MedServRx to determine the lowest price for every prescription — and compare those prices against the deductible for the same prescription, if they use their coverage. That means greater access and more choice for patients.
Patients with limited, High Deductible or no insurance benefit from having access to the lowest possible cash price for any prescription. What’s more, MedServRx offers its program as an added benefit that employers can give their employees — at no cost to employers or employees.
As with other discount cards, patients can use their provider’s easy-to-use MedServRx website to search — and compare prices among participating local pharmacies — for drugs by name. Additionally, MedServRx enables patients to search for prescription discounts by dosage quantity (or volume) and by method of delivery (IE: capsules vs. liquid). This added search capability gives patients the advantage of true price comparison based on their individual needs.
MedServRx support for patients who can’t afford prescriptions
On every participating health system’s MedServRx website, patients who can’t afford their prescriptions are encouraged to report the problem to their doctor — or to a nurse or staff member at their physician’s office. MedServRx is often able to help qualify those patients for additional financial support.
Improving patient access to better healthcare
MedServRx was created to further the goals of the healthcare consumerism movement. Offering patients greater access to care, and to affordable prescriptions, without always having to go through insurance companies. It’s a particularly attractive solution, in a time of high inflation (particularly inflated drug prices) for patients with high deductibles or no insurance.
It helps physicians provide their patients with additional access to the prescriptions they need, while improving their value-based reimbursements
What’s more, participating health systems’ pharmacies owned and/or managed by ProxsysRx — like The Pharmacy at Hunt Regional — offer patients additional adherence-facilitating support services, such as: Free mail-to-home delivery. Generic cost-plus pricing. Medication synchronization. Patient-prescription consulting. And refill reminders.
ProxsysRx staff also provides local support to clinics, pharmacies and patients through 24/7 help lines and email support. This helps relieve a significant burden on providers’ staffs by fielding patient questions for them.
Get MedServRx for your health system. And your patients!
For more information, contact Richard Thomas C: 205.612.0462 | richard.thomas@proxsysrx.com OR Micah Russell. C: 205-566-7420 | mrussell@proxsysrx.com
