Written by: John Mack of Pharma-Mkting.com
There are millions of people who are without insurance for
prescription drugs. Medicare and pharmaceutical company patient
assistance programs
have helped, but there is still room to do more.
A free prescription drug card offered by YourRxCard.com of
Baton Rouge, LA attempts
to fill the gap in coverage.
Gaps
“We estimate is that there are 25-26 million Americans
that have no Rx drug coverage at all,” says Rex Bowden, President,
which runs YourRxCard.com. The site offers discounts
up to 75% of the cost of drugs.
“Everyone is eligible,” says Bowden, “but we are targeting people
with no insurance or who are underinsured or have
high deductible insurance or have gaps in their Rx coverage.” Millions
of Americans fall into one or another of these categories.
The Medicare Part D prescription coverage, for example, includes
the infamous “doughnut hole,” which is reached when a beneficiaries’
annual drug spending hits $2,250, at which point
they will have to pay $3,600 in out-of-pocket costs before coverage
resumes. It
is estimated that 6.9 Medicare enrollees could reach
the hole.
While the pharmaceutical industry has patient assistance programs
to help patients who cannot afford their medications,
these cover only a portion of the need. For one thing, eligibility
varies and
not all drugs may be covered. Some companies will
only help if applicants are not receiving any other private or publicly
funded drug benefits.
Medicare and PAPs
Until recently pharmaceutical companies were not permitted to provide
Medicare Part D beneficiaries with drug discounts under
their Patient Assistance Programs (PAPs) without violating the anti-kickback
statute.
That statute prohibits offering or receiving payment
to increase the use of products or services (in this case, to steer
prescription
drug use) at the cost of federal health care programs.
In April, 2006, however, Schering-Plough reported that the U.S.
Department of Health and Human Services (HHS) Office
of the Inspector General (OIG) issued a favorable advisory opinion
stating that the
company's inclusion of Medicare-eligible patients in
its patient assistance programs is consistent with OIG guidelines.
“This is excellent news for the many people with Medicare who have
relied on these valuable patient assistance programs,” HHS Secretary
Mike Leavitt said. “Medicare beneficiaries with limited means will
now have the peace of mind knowing their prescription
drug needs will be met, through Medicare drug coverage plus the prescription
assistance programs.”
Medicare coverage reduces the load on pharmaceutical assistance
programs and provides extra help for beneficiaries with
limited means, allowing manufacturers to continue their assistance
programs for
people with Medicare drug coverage.
See “HHS Applauds Pharmaceutical Patient Assistance Programs”, http://www.hhs.gov/news/press/2006pres/20060418a.html
YourRxCard.com is unique in that it is free – there is no premium as
in gap coverage programs offered by organizations like AARP, which is
also subject to a deductible or co-pay and there is a premium that must
be paid by each participant in the program.
“Also, many people learn when they try to use these programs that
one or more of their drugs may not be covered because they are not
in the formulary for the plan,” says Bowden. “The free YourRxCard program
does not distinguish between formulary and non-formulary drugs. If
it’s a prescription drug, it’s covered by the program and at least
some discount is available. Everyone can benefit from this program
– even people who participate in other programs.”
How Can It Be Free?
YourRxCard is a form of patient assistance program,
but it is run by participating pharmacists who benefit by getting
immediate payment at the point of sale rather than waiting for re-imbursement
by Pharmacy Benefit Managers (PBMs). For the pharmacist, the YourRxCard
progarm is better than a traditional card program where payment is
made by a third party (eg, government or employer) after a delay.
Each participating PBM works through a network of pharmacies that
have agreed in advance to a discount for all drugs under the program.
“Typically you see a price that is in the range of average wholesale
price minus 14%-15% plus a modest dispensing fee of depending on the
PBM,” says Bowden.
Features and Benefits of YourRxCard.com
• It’s free!
• Everyone is eligible to participate. Mature Adults,
Young Adults, Children, Self Employed, Employed, Un-Employed, Part
Time Employed, Seasonal Workers, Temporary Workers, People who missed
or don’t like Medicare D programs, poor, rich, charitable, sick,
etc.
• Save up to 75% off drug retails prices.
• It’s like having a repeat Rx coupon on every drug.
• Instant Activation – just print your card and use
it!
• Over 50,000 USA Major Pharmacies Accepted.
• Includes an online Pharmacy Locator and a Medication
Pricing that helps enrollees compare discounted prices at local pharmacies
before picking up their prescriptions
• Includes a Medication Comparison Tool that can
identify equivalent generic medications.
• No Chinese, Mexican or Canadian Counterfeit Fake
Drug Risks.
The YourRxCard.com Web Site
Anyone can sign up and instantly get a YourRxCard
by accessing the Web site and entering minimal
information: first name, last name, e-mail address (see Figure
1).
Figure 1: YourRxCard.com home page showing printable discount cards
superimposed.
A scrolling window on the Web site shows some examples
of typical, actual savings, which vary by location due to volume
and competition. The following table illustrates just two examples:
The Pricing Tool
If you click on “MEDICATION PRICING,” you can get an
instant estimate of the discounted price for any drug entered (see Figure
2). Drug prices may vary slightly from pharmacy to pharmacy. The Pharmacy
Tool allows users to see the latest online prices offered by pharmacies
in there area (see Figure 3).
Figure 2: Drug Pricing Tool. This shows the average or typical discount
prices available for the selected drug, including it’s different dosage
forms. You can then click on the appropriate tool for more detailed
information, such as the price of 40 mg tablets of Pravachol at local
pharmacies (see Figure 3).
Figure 3: The Pharmacy (Pricing) Tool. This shows the latest discount
prices of 40 mg Pravachol tablets in my local area pharmacies. It’s
interesting that although gas is cheaper for me in neighboring Richboro,
drugs like Pravachol are actually more expensive there!
Everybody Wins
Bowden, who has 31 years of experience in employee
benefits and group health insurance for large employers, believes
that the YourRxCard program represents one of the rare situations
where everybody wins. “The patient who needs the drug obviously wins,”
says Bowden. “An the pharmacy and pharmaceutical companies win by
offering products at lower prices to people who otherwise may not
be able to afford them. It’s like having a repeat discount coupon
for every drug”
The more people that use the program, the greater the benefits will
be. The main challenge right now is getting the word out. Bowden hopes
that everyone that reads or learns about this program will help pass
the web site location and word of the program to others. www.yourRxcard.com
