n HOW DOES PHARMACY CARVE-OUT WORK?
Spending for prescription drugs has more than quadrupled in the last 15 years. It is the fastest-growing cost-component of a $2 trillion health industry. This trend will only gain velocity in the years ahead. Prescription drug costs are expected to jump from $190 billion in 2003 to as much as $446 billion in 2012. "Carve-Out" means that you separate a segment of your health plan — the prescription drug benefit — to have it administered by a specialist third party administrator (HISI). The account then can be fully-insured or self-funded with or without Stop-Loss Insurance.
Insurance Carriers use the prescription drug portion of a medical benefits package as a major profit center. By "Carving-Out" Pharmacy Benefits the client saves money without reducing benefits. HISI matches the existing plan side-by-side and manages the account so that the employer only pays for what they actually use. Our administrative fees are only a fraction of what the large carriers charge and therein lies substantial savings.
Here are some benefits to a self funded carved-out pharmacy plan:
Pharmacy benefit managers (PBM's) maintain discount contracts with a network of pharmacies. They adjudicate claims in real-time, provide customer service support, employ their own clinical staff, report plan results directly to you.
Pharmacy benefit managers-or PBMs-offer a wide range of benefit management services for corporations, insurance companies, unions, government employee groups, and managed care organizations. The key function of a PBM is to enable a plan sponsor's employees to obtain covered medications safely, conveniently, and less expensively.The PBM business model was developed in response to significant increases in the costs of prescription drugs. PBMs focus on the following areas of concern:
Improving overall health and safety through comprehensive prescription care
Enhancing accessibility of pharmacy services and increasing the efficiency of drug benefits administration
Containing costs of drug benefits
Encouraging consumers to be cost-conscious when it comes to using their pharmacy benefit
What is the value of carving-out with a PBM? In a word - Cost containment. A comprehensive, carefully designed drug benefit should result in lower costs for our clients and better health for their employees. Through careful management of utilization and cost, HISI in partnership with the client can ensure substantial savings in overall employer health costs. HISI has contracted with multiple PBM's including the two leaders in the industry, ExpressScripts and CVS/Caremark.
n OUR BROKER PARTNERS HAVE AN ADVANTAGE ON THE COMPETITION !
Brokers and Benefit Consultants - Let us show you a unique sales advantage for obtaining new accounts and retaining existing clients at their renewal - PHARMACY CARVE-OUT. We have all the tools to assist you in presenting this option to your clients - from custom Power Point presentations to easy-to-follow handouts.
Our Pharmacy team can create a custom plan that will fit perfectly with any client's needs. By separating pharmacy from medical/dental benefits, there are substantial savings for the client that will be carefully monitored and managed by our staff. Stop-Loss Insurance can be added to guarantee cost savings in the event of catastrophic claims.
THE BOTTOM LINE: The client saves money and you, as the broker or consultant have a unique marketing edge over your competition! Contact our office for more specific details.