Lowering 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
EmsanaRx 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 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
Employers 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.