Self Funded Pharmacy Program
Information below is from the Self Funded Pharmacy vendor.
New Jersey Hospital Association (NJHA) Pharmacy Benefit Management
A self-insured PBM product with rates negotiated at the 100,000 + level. All types of employers are invited to utilize the program not only hospitals.
National attention is focused on prescription drugs due to rapidly rising prescription costs and issues relating to implementation of the new Medicare drug benefit. Growing concerns about the affordability of needed drugs, coupled with the significant profitability of drug manufacturers are causing policymakers and others to consider new approaches for addressing drug costs. The solution is to break the traditional barriers and unbundle the varied services, providing a greater knowledge of the actual ingredient costs of prescriptions, a greater control of product selection, revenue gain from the formulary rebate proceeds and ultimately reduced overall costs. Typically, the savings generated are a minimum of 10% on overall drug spend.
The NJHA PBM program is a full service PBM that cuts out all of the fat. Employers pay the exact rate under contract with the pharmacy, retain 100% of rebates and pay the PBM in an appropriate manner – for their administration of the program.
Marketed By:
Emerson Reid & Company
4651 West Chester Pike
Newtown Square, PA 19073
(610) 356-9220
PBM Claims Processor:
Express Scripts, Inc.
13736 Riverport Drive
Maryland Heights , MO 63043
(800) 524-4491
Highlights
* Full service PBM including mail order and specialty
* Any size self insured companies
* Access to contractual rates available typically for employers of 100,000+
* National, reputable PBM processor
* Utilize your plan design, ultimate flexibility
* The most comprehensive Account Management and reporting packages in the industry
* Association membership not required
* Over 55,000 pharmacies participating nationwide
Request for NJHA PBM Savings Analysis
The following is the list of information necessary to conduct a thorough pharmacy benefit analysis. Please forward the following data for a specified time period of at least six months.
Retail Pharmacy Program:
* Brand - % discount off AWP
* Generic - % Discount off AWP or MAC
* Dispensing Fee (brand/generic)
* Electronic Claims (per claim and/or pepm)
* Manual claims
* Co-payment/Benefit Structure
Mail Order Pharmacy Program (if applicable):
* Brand - % discount off AWP
* Generic - % Discount off AWP or MAC
* Dispensing Fee (brand/generic)
* Administrative Fee (per claim and/or pepm)
* Co-payment/Benefit Structure
Formulary/Rebate Program:
* Percentage of Gross Rebates attributable to our plan.
*
Amount of Rebates paid to client in past 12 months.
*
Rebate per script retail vs. mail *
Most importantly, we need detailed pharmacy utilization reports for the last 12 months . The following need to be included in the reports:
* Total scripts
*
Total ingredient cost
*
Total dispensing fees
*
Total administrative fees
*
Total covered members or employees
The above should be broken out by retail (brand vs. generic) and mail service (brand vs. generic)
* Top 100 drugs by cost and # of Rxs
*
Claim data including 11 digit NDC number, amount paid, mail or retail fill indicator and fill date for the most recent quarter in a Microsoft Excel 2000 or greater format