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Mark Cuban And EmsanaRx Plus Are Taking On The Self-Funded Employer Drug Market

January 23, 2023, by New City Insurance

medicine shoppingLowering drug costs has always been a top priority for self-insured employers. According to a report published by the National Alliance of Healthcare Purchaser Coalitions, more than 60 percent of US employers say that medication costs and related expenses are increasing at an unsustainable rate.

To lower drug costs for self-insured employers, Mark Cuban’s Cost Plus Drug Company (MCCPDC) partnered with the Purchaser Business Group on Health (PBGH) to provide self-insured employers with discounted prescription drugs via a new platform referred to as EmsanaRx Plus.

Products will be offered to self-insured employers of all sizes and are not exclusive to PBGH members.

Mark Cuban and PBGH Launch EmsanaRx Plus

Employers throughout the United States have voiced their concerns that the health-care services they purchase are often not of high quality, despite their excessive cost. In response to these ongoing concerns, many companies have sought to lower medical costs in recent years without sacrificing quality care for employees.

PBGH, a national employer group, started this new venture to develop health-care products for large employers that addressed the frustration that many employers feel due to unmet employee needs and rising costs.

EmsanaRx will develop a variety of products designed for PBGH member organizations, such as Microsoft, Walmart, Costco, Tesla, and Intel, among others. However, the products will also be available to outside companies as well. EmsanaRx’s business incentives are carefully structured to align with employer needs.

Employers will have access to more offerings, as well as greater control and transparency. Among these offerings are fixed prices per prescription and a dedicated clinical pharmacist account manager who will partner with employers to develop their own pharmacy network.

Companies With EmsanaRx Plus Can Expect Lower Prescription Prices

close up of patient with prescriptionEmsanaRx Plus was created to act as a supplement to employers’ existing drug benefits and to aid beneficiaries in finding lower-cost medications and discounts. According to a recent press release, EmsanaRx Plus is a new and innovative supplemental drug discount product designed for employers.

With this new service, beneficiaries can gain access to lower-priced drugs through their employers’ self-insured health-care plan instead of having to use drug discount cards through a third party.

With EmsanaRx Plus, employers can rest assured that all prescriptions from MCCPDC are paid and fulfilled. Reports are provided to employers containing all drug cost information. In addition, a flat, nominal per prescription fee of 1.5 percent will be collected for each insurance claim and the company will pass on any rebates that are collected.

According to founder and CEO of MCCPDC, Alex Oshmyansky, independent consultants have found that customers can save upwards of 60 percent on generic medications when using the company’s pricing models.

More Access to Generic Drugs Helps Better Manage Inflation Costs

According to a recent report published by the Department of Health and Human Services (HHS), list prices on over 1,200 prescription medications rose faster than inflation between July 2021 and July 2022, resulting in an average increase of 31.6 percent.

The recently enacted Inflation Reduction Act prevents pharmaceutical companies from raising the price of their products past the rate of general inflation without having to pay Medicare a rebate for the price hikes. Starting in October 2022, price tracking was also implemented to assess rebates.

Another report published by HHS found that the United States health-care system spends more each year on prescription medications mostly due to price increases. The Inflation Reduction Act includes a provision to address this drug pricing which will allow HHS to better negotiate the cost of certain prescription medications covered by Medicare Parts B and D.

EmsanaRx Challenges the Influence of PBMs on Drug Pricing Increases

pharmacy benefits managerPharmacy benefit managers (PBMs) are responsible for managing drug benefits on behalf of large employers, health insurers, and other payers. They have played a key role in determining how much pharmacies are paid and how patients access their medications.

The anticompetitive practices of PBMs in relation to generic drugs have been well documented. Pharmacy benefit managers use their position as middlemen between products, dispensers, and drug payers to require pharmacies to sign contracts that give them the lowest prices possible.

In turn, this discourages pharmacies from undercutting PBM costs with cash prices even when pharmacies could make a profit doing so. Complicated business practices also allow PBMs to hide their unjust profit margins.

Today, payers and patients are being charged up to 20 percent too much for generic medications, resulting in billions of dollars in overpayment. EmsanaRx Plus is designed to challenge the influence of PBMs on rising drug prices by providing services that will include generic drugs and eventually extend to some branded drugs.

PBMs Are Directly Responsible for Drug Price Increases

There has been ongoing controversy regarding who is controlling drug prices. PBMs claim to work for insurers to acquire low-cost drugs from manufacturers; however, PBMs also claim that drug manufacturers are responsible for setting drug prices.

According to the National Community Pharmacists Association (NCPA), PBMs raise medication costs by nearly 30 percent due to rebates that they charge manufacturers to remain on their formularies.

So, who benefits from these rebates? It is not the pharmacies or the patients. Instead, rebates benefit the PBM’s executives and their bottom line. There is also a common misconception that physicians and pharmacists are in charge of prescription-related decisions.

When a physician prescribes a drug for their patient, that decision is solely based on what is in the best interest of the patient. When dispensing a drug, a pharmacist also provides services based on the patient’s unique circumstances.

PBMs Will Be Forced to Be More Transparent With Pricing

pbm conceptEmployers across the US are recognizing that they are being negatively impacted by an unbalanced industry that continues to increase drug costs without adding any real value.

By partnering with MCCPDC, EmsanaRx aims to help employers better understand where high-cost medications are a problem in their current benefit design, as well as provide employers and their employees with lower-cost alternatives.

EmsanaRx Plus has the potential to save employers millions of dollars on their pharmaceutical spending with minimal effort. In addition, the implementation of this platform could help the system save money overall. Transparent pricing will allow patients who have high-deductible health plans to save money on their medications.

Since EmsanaRx Plus was first introduced to the market, countless employers, startup PBMs, patients, and insurers have shown interest in working with MCCPDC. The platform is also putting pressure on legacy PBMs to explain the reason behind their inflated costs which are much higher than that of new start-ups.

New City Can Compound Savings With Customizable Health Plans While Staying In Network

Self-insured employers looking to cut down on prescription drug costs and develop more attractive benefits packages are realizing the appeal of EmsanaRx Plus. The program will provide drug discounts to employees without requiring them to go outside of their health-care plan. It will also coordinate with providers on employees’ behalf to transfer their prescription medications to lower-cost options.

Working with an employee benefits consulting firm that specializes in benefits consulting and insurance can help reduce costs without reducing network access or benefits. The experienced team of benefits consultants at New City Insurance can help employers maximize their savings by offering customizable health plans that allow employees to stay in the network. Request a consultation with New City Insurance today and learn a better way to structure employee benefits.

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New City Insurance
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Carol Zhang
Carol Zhang
04:29 06 Mar 22
As a rapidly expanding national media organization, the employee benefits strategy and administration that New City has provided us during our growth has been invaluable. They have been proactive about informing us of the different benefit strategies available to us as we grow as well as managing the additional compliance laws and reporting requirements at each stage of our growth.
Claudia Villalobos
Claudia Villalobos
20:14 03 Mar 22
New City Insurance made navigating through all the health insurances super EASY. Their documents are highly informative, professional, and easy to work with. Thank you for making the process of choosing a health plan so simple. You guys are THE BEST!
Philippe Salas
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I never expected to have a good time talking to an insurance salesman, but let me tell you Brendan was quite the treat. He was very helpful explaining the options and has a wonderful sense of humor. I hope to speak with him every time I call.
Jennifer Polito
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Super easy enrollment process. Fast and friendly customer service. If you are looking for an insurance company that is there for you every step of the way I highly recommend New City Insurance.
Rocky Salas
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23:46 07 Jan 22
So friendly, I hope to speak to him again in all my future insurance needs.
Rocky Salas
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So friendly and soft spoken. I hope to speak to him again in all my future insurance needs.
Jose Brena
Jose Brena
13:20 06 Jan 22
Eric Calciano has been extremely helpful in finding and selecting the right insurance coverage for our company. With many options out there Eric assisted us on getting a low cost provider saving more than 20% than from our competitors and providing excellent coverage for our employees.
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Signing up for insurance was quick and easy. Felicity Sundsboe
SFCC
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22:08 29 Nov 21
Jeff Stoltey and his team provide excellent customer service. Jeff has always provided my company SFCC with straightforward options. I went to a larger insurance company only to RUN BACK to Jeff at New City Insurance. I recommend them to anyone needing insurance without hesitation.
Kevin Luby
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19:13 22 Oct 21
Quick, easy & informative. We were able to secure quality insurance for our small business on a tight deadline. Thanks for the help New City.
Theresa Ruybol
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19:30 01 Jul 21
Eric was so great with us. He was very patient and kind as we are a newer smaller organization who is growing rapidly. With that said, we had made our inquiry, he had great rapid response and mostly had to wait on me. Any request that we made and/or questions we had, he was great answering and helping us understand. Then when we were ready for all documents and to move forward, Brendan helped with getting that together and the two of them worked their magic on New City's end to notify me of what was needed, assist me in that process and confirming that all was complete and approved for the coverage. I just want to say thank you all again so much, as insurance has always been confusing to me, and you all made that process go a lot smoother.Thank you
Andrea Ordendorff
Andrea Ordendorff
21:06 07 May 21
I've been working with both Clayton and Brendan for well over a year. As the purchase of our dental practice was delayed well over 14 months they both patiently supported me and continued to make themselves available. When we were officially ready to sign up they made the whole process seamless and super easy. This team is highly knowledgeable, professional, supportive, and efficient! I can't thank them enough for everything they've done.
T W
T W
22:32 30 Aug 20
I love New City Insurance. I never had a good experience dealing with insurance brokers until I started working with Brendan. He’s awesome! He is patient with me and takes the time to answer all my questions. I’m very grateful for all his help and hard work!
Mary Jane Deyette
Mary Jane Deyette
00:57 11 May 20
Jeff Stoltey is so awesome...even thru my company had only two employees, he took the time each year to research and find the best plan for us. The only reason I am leaving New City Insurance is because we no longer have any employees. Thank you Jeff
Alma Ortiz
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22:25 23 Feb 20
Brendan was awesome! I couldn't figure out how to pick my plan and he returned my call on a weekend to help me. Outstansing service!
jessica kavanagh
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Brendan was so helpful I definitely recommend him if you’re in need of good help and getting it done promptly. Thankyou so much again.
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I was very thankful I inquired about this info. with Brendan. He was very helpful so I understand the benefits available much better now. Thank you Brendan.
B Bayer
B Bayer
17:43 24 Sep 19
NCI handled almost everything from start to finish. Clayton and Brendan made the plans easy to understand and walked me through the application process. They got me my ID numbers before my cards arrived so that I could keep an appointment I had already scheduled. My last broker wouldn't have done that. 5 stars!
Jessica Lehr
Jessica Lehr
03:36 07 Jun 19
Our staff was interested in a health plan, but we didn't know how beneficial a solid employee benefits package would be for our business to expand. We'd lose prospective employees because they had more options for their medical insurance which was sometimes more valuable than more pay. The New City team was amazing and gave us as many affordable options as possible so that everyone had their needs met.
Mike McClay
Mike McClay
19:36 03 May 19
My employer uses New City as their insurance broker, and I'm always amazed when I call in for assistance by how knowledgeable and attentive their staff is with my requests. Their online benefits platform makes selecting insurance plans pretty darn easy. I would highly recommend their services.
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