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As healthcare costs rise, prescription drugs can be one of the costliest aspects of the healthcare experience. In an interview, RxSaveCard CEO and Founder Chris Crawford talked about his new business and its mission to bring down the cost of prescription medication.
Crawford’s background is in employer benefits consulting, starting with Mercer. He later launched his own consulting business before Cottingham & Butler acquired it in 2015. Since then, Crawford has worked as a chief growth officer with pharmacy benefit consulting firms HealthStrategy and VIVIO before launching RxSaveCard last year.
The rising costs of prescription drug spend
“The rising cost of healthcare particularly impacts self-insured employers and they’re looking for ways to pare down healthcare costs. Prescription drugs are the most used employee benefit,” Crawford observed. Emerging technologies such as cell and gene therapies have come to market with hefty price tags, but the groups of patients who use them are relatively small.
“On the other hand, the rise of GLP-1 drugs to treat obesity, considered a chronic condition, means these medications costing $11,000 to $13,000 are in high demand,” Crawford said. “Only 18% of employers with 200+ employees are currently able to cover GLP-1s due to the high cost, even though approximately 35% to 45% of employees could be prescribed one of these medications.”
Crawford explained that pharmacy benefit managers (PBMs) compound the problem, as they make money by marking up the cost of drugs (known as “spread pricing”), often making drugs more expensive with insurance. He founded RxSaveCard because drug prescriptions often cost less when individuals use cash instead of insurance to pay for them.
Chris Crawford
How it works
Working in collaboration with retail pharmacies, Mark Cuban’s Cost Plus Drugs and other pharmacy partners, RxSaveCard helps employers access cash prices at over 65,000 pharmacies without changing their PBM.
The rise and influence of the three major PBMs, each aligned with an insurer, is tough to counter. Critics are vexed by the lack of transparency by PBMs. Although a new generation of PBMs tend to be smaller and more transparent, their market share is less than 10%, according to Crawford.
“Ninety percent of employers do business with the major PBMs. That’s not changing anytime soon,” Crawford acknowledged. “We’re not asking employers to change their relationships. RxSaveCard is a much-needed companion to the employer’s PBM.”
RxSaveCard is accomplishing this through an innovative payment model. Employers decide the pharmacies where they would like the RxSaveCard to be authorized to purchase prescriptions for their employees. They control how much they want to contribute towards each prescription and how often. There is no pre-funding required of the cards, so employers only spend money when the RxSaveCard is used to purchase lower-cost drugs. The card gives employees the power to find the lowest prices on their medications at pharmacies, including online programs like Mark Cuban’s Cost Plus Drugs, according to the company’s website. At the pharmacy counter, the RxSaveCard instantly compares the cash price from multiple discount cards, ensuring the lowest cost. Employees receive lower out-of-pocket costs, in many cases getting their prescriptions for free.
Case studies
Crawford offered some use cases to illustrate how the card works.
In one scenario, an employee diagnosed with bipolar disorder relies on Lurasidone (Latuda) to manage his symptoms. The cost of his medication through his employer’s PBM is $1,664.77 for a 90-day supply. Of that, the employee paid $332.95 out-of-pocket, while his employer covered $1,331.82. This same exact drug costs $23.50 with RxSaveCard.
His employer saves $1,308.32 per fill ($5,233 annually), while the employee saves $332.95 per 90-day fill — saving $1,331 in a year. This reduced financial burden allows the employee to focus on his health without the stress of being able to afford his medication.
In another scenario, an employee actively battling cancer relies on an oral medication, Imatinib (Gleevac), as part of his treatment. While dealing with the challenges of cancer, a 30-day supply of his medication costs $6,067.69 through his employer’s PBM. Of that, the employee paid $1,213.54 out-of-pocket, while his employer covered $4,854.15.
With RxSaveCard, the total cost of the drug is just $13.18 through Cost Plus Drugs. His employer pays $13.18 and the employee gets his cancer medication for free.
“When things are run through insurance, you are often shielded from the true costs of what drugs such as insulin are while there are discount cards that let you buy insulin for $35 — so our view is this should be the market price for it,” Crawford said. “When things run through a PBM, [the PBMs] make money by adding costs to the drug. I think what we’ve seen with this emergence of the cash marketplace is if you take the middleman out and just allow pharmacies to sell directly to consumers at that cash price, that’s often where you see things being less expensive.”
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