As healthcare prices rise, prescribed drugs may be one of many costliest facets of the healthcare expertise. In an interview, RxSaveCard CEO and Founder Chris Crawford talked about his new enterprise and its mission to convey down the price of prescription medicine.
Crawford’s background is in employer advantages consulting, beginning with Mercer. He later launched his personal consulting enterprise earlier than Cottingham & Butler acquired it in 2015. Since then, Crawford has labored as a chief progress officer with pharmacy profit consulting corporations HealthStrategy and VIVIO earlier than launching RxSaveCard final yr.
The rising prices of prescription drug spend
“The rising value of healthcare significantly impacts self-insured employers they usually’re on the lookout for methods to pare down healthcare prices. Prescribed drugs are essentially the most used worker profit,” Crawford noticed. Rising applied sciences akin to cell and gene therapies have come to market with hefty worth tags, however the teams of sufferers who use them are comparatively small.
“Alternatively, the rise of GLP-1 medicine to deal with weight problems, thought of a persistent situation, means these medicines costing $11,000 to $13,000 are in excessive demand,” Crawford mentioned. “Solely 18% of employers with 200+ workers are at the moment capable of cowl GLP-1s because of the excessive value, though roughly 35% to 45% of workers could possibly be prescribed one in every of these medicines.”
Crawford defined that pharmacy profit managers (PBMs) compound the issue, as they make cash by marking up the price of medicine (often called “unfold pricing”), typically making medicine dearer with insurance coverage. He based RxSaveCard as a result of drug prescriptions typically value much less when people use money as a substitute of insurance coverage to pay for them.
The way it works
Working in collaboration with retail pharmacies, Mark Cuban’s Value Plus Medication and different pharmacy companions, RxSaveCard helps employers entry money costs at over 65,000 pharmacies with out altering their PBM.
The rise and affect of the three main PBMs, every aligned with an insurer, is hard to counter. Critics are vexed by the dearth of transparency by PBMs. Though a brand new era of PBMs are typically smaller and extra clear, their market share is lower than 10%, in line with Crawford.
“Ninety p.c of employers do enterprise with the main PBMs. That’s not altering anytime quickly,” Crawford acknowledged. “We’re not asking employers to alter their relationships. RxSaveCard is a much-needed companion to the employer’s PBM.”
RxSaveCard is conducting this by an modern fee mannequin. Employers resolve the pharmacies the place they want the RxSaveCard to be approved to buy prescriptions for his or her workers. They management how a lot they wish to contribute in direction of every prescription and the way typically. There isn’t a pre-funding required of the playing cards, so employers solely spend cash when the RxSaveCard is used to buy lower-cost medicine. The cardboard offers workers the facility to search out the bottom costs on their medicines at pharmacies, together with on-line packages like Mark Cuban’s Value Plus Medication, in line with the corporate’s web site. On the pharmacy counter, the RxSaveCard immediately compares the money worth from a number of low cost playing cards, guaranteeing the bottom value. Workers obtain decrease out-of-pocket prices, in lots of circumstances getting their prescriptions totally free.
Case research
Crawford provided some use circumstances for instance how the cardboard works.
In a single state of affairs, an worker identified with bipolar dysfunction depends on Lurasidone (Latuda) to handle his signs. The price of his medicine by his employer’s PBM is $1,664.77 for a 90-day provide. Of that, the worker paid $332.95 out-of-pocket, whereas his employer lined $1,331.82. This similar actual drug prices $23.50 with RxSaveCard.
His employer saves $1,308.32 per fill ($5,233 yearly), whereas the worker saves $332.95 per 90-day fill — saving $1,331 in a yr. This decreased monetary burden permits the worker to give attention to his well being with out the stress of with the ability to afford his medicine.
In one other state of affairs, an worker actively battling most cancers depends on an oral medicine, Imatinib (Gleevac), as a part of his remedy. Whereas coping with the challenges of most cancers, a 30-day provide of his medicine prices $6,067.69 by his employer’s PBM. Of that, the worker paid $1,213.54 out-of-pocket, whereas his employer lined $4,854.15.
With RxSaveCard, the full value of the drug is simply $13.18 by Value Plus Medication. His employer pays $13.18 and the worker will get his most cancers medicine totally free.
“When issues are run by insurance coverage, you might be typically shielded from the true prices of what medicine akin to insulin are whereas there are low cost playing cards that allow you to purchase insulin for $35 — so our view is that this needs to be the market worth for it,” Crawford mentioned. “When issues run by a PBM, [the PBMs] make cash by including prices to the drug. I feel what we’ve seen with this emergence of the money market is should you take the intermediary out and simply permit pharmacies to promote on to shoppers at that money worth, that’s typically the place you see issues being inexpensive.”
Image: Photograph: z_wei, Getty Pictures
