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Rx Calculator

The proceeding calculations assume that 4% of covered individuals use the combination of listed medications, minus Revlimid. Revlimid savings listed at the end, for those who have a user in their population. Savings will vary based on your company's actual usage. Potential savings from using a transparent PBM are not included in calculations because there are too many variables.

PBM – Pharmacy Benefit Manager

  • Responsible for determining what drugs are covered, what tier they fall into, and what drugs are preferred over others.
  • Three main managers are CVS Caremark, Express Scripts, and OptumRx.
  • These main PBMs can charge large (sometimes massive) spreads between true drug costs and the price charged, making many prescriptions prohibitively expensive.
  • There is an option to use transparent PBMs, which are transparent in their fees. They do not make a profit from a revenue spread, and instead charge a set fee (typically $1-15) per prescription filled, which differs based on how many individuals are on the plan.

MAP – Manufacturer’s Assistance Program

  • Many drug manufacturers offer assistance programs to significantly reduce or eliminate copays for their drugs for eligible patients.
  • These programs have three general requirements:
    1. That you are a permanent, legal resident of the United States or Puerto Rico
    2. Prove that you are uninsured or that your insurance doesn’t cover the medication
    3. You must meet certain income eligibility requirements, which differ by program

IPP – International Pharmacy Procurement

  • Many developed countries have price control on prescription medications, which means they have significantly lower prices. These countries include Canada, Australia, Singapore, and many countries in western Europe.
  • IPP essentially involves pharmaceutical companies shipping medications to international pharmacies, having those pharmacies fulfill the prescription, and then shipping the medications to the patient.
  • As long as the fulfillment is a direct route like this, it is legal and generally saves the patient a great deal of money.

340B Programs

  • Federal program that requires pharmaceutical manufacturers participating in Medicaid to provide outpatient drugs at discounted prices to qualifying providers.
  • Eligible providers include many hospitals, specialized clinics, and certain health centers, including Tribal/Urban Indian Health Centers, and Native Hawaiian Health Centers.
  • Designed the better fund Medicare and Medicaid by reducing government spending on ever increasing drug prices. Not every drug is eligible for the program, but many are, especially those that weigh heavy on the federal budget.

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