This presentation provides a comprehensive explanation of the Community Assistance Program (CAP) and the outreach effort behind the Rx discount card to help the un-insured and under-insured fill their medications more affordably at their local pharmacies.
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CAP Rx Discount Card Presentation
1. Savings
Community Assistance Program
Making healthcare more affordable
A free resource to help your un-insured and
under-insured patients save money on their
prescription medications.
1-866-889-1662
www.USMedSavings.org
info@usmedsavings.org
www.facebook.com/communityassistanceprogram
2. Topics explained in this Slide Presentation:
Explanation of an Rx savings card - Slides 3 & 4
How discounts are created on Rx at local pharmacies - Slides 5 - 9
Explanation of the Community Assistant Program (CAP) outreach effort -
Slides 10 & 11
Commonly asked questions - Slides 12 - 26
Additional Tools:
How to use the Pharmacy & Rx pricing lookup tools - Slides 27 - 34
Languages available for the Rx savings card - Slide 35
Other resources provided through CAP:
Rx Med Assist (a Prescription Assistance Program) - Slides 37 & 38
CAP Diabetic Program (diabetic testing supplies) - Slides 39 - 40
Contact information - Slide 41
3. What is a Prescription Drug Discount Card?
A resource for people who are
under-insured or un-insured to
help them save on their
prescription medications at their
local pharmacy.
A resource designed to provide
quick and easy access to more
affordable prescription drug
pricing.
4. How are the Discounts Established With
an Rx Savings Card?
The vast majority of pharmacies nationwide contract with Pharmacy Benefit Mangers
(PBMs) to establish pricing structures on medications for health care plans.
For non-insurance Rx savings cards, discounted pricing for name-brand and generic
medications are established in this same way to help un-insured and under-insured
consumers more affordably fill their medications.
Pharmacies benefit from this collaboration through increased store foot
traffic, enhanced customer loyalty and added sales of pharmacy & non-pharmacy
goods and services.
A few things to know…
Roughly 70% of the three billion prescriptions filled each year in
the US are handled through Pharmacy Benefit Managers
(PBMs).*
PBMs handle pharmacy benefits for nearly 200 million Americans
including 65% of the country’s seniors.*
* Source: Report to the FTC; ―PBMs: The Basics and an Industry Overview‖ – The Health Strategies Consultancy, LLC 2003
5. Pharmacy Benefit Manager (PBM)
Relationships
Pharma
Manufacturer
Figure 1
This diagram (Figure 1)
illustrates the various
connections PBMs have
Retail
Pharmacies
PBM Employer/
Plan Sponsor
throughout the health care
industry.
Health Plan/
Insurance
Company
Source: Report to the FTC; ―PBMs: The Basics and an Industry Overview‖ – The Health Strategies Consultancy, LLC 2003
6. HealthTrans® , a Leading PBM Allowing Access
to Rx Savings Card Discounts
Pharma
One of the largest, most established Manufacturer
PBMs is HealthTrans®. (see Figure 2)
HealthTrans has an A+ rating with
the Better Business Bureau.
Retail Employer/
HealthTrans®
HealthTrans® is the PBM for the Pharmacies
(PBM)
Plan Sponsor
discount Rx savings cards we mail
to you as a part of a grassroots
outreach effort (Community
Assistance Program (CAP)) to
help people who are un-insured
and under-insured. Health Plan/
Insurance
Company
Figure 2. illustrates HealthTrans’
relationship to the CAP grassroots outreach effort to
help people receive discounts on their Rx meds.
7. HealthTrans® (PBM), Pharmacies, and the Discount Rx
Savings Card Provided Through the CAP Outreach Effort
Pharma
Manufacturer
Figure 3 illustrates the
relationship between HealthTrans® Figure 3
and retail pharmacies to show
how they relate to the CAP
outreach effort.
Retail HealthTrans® Employer/
(PBM) Plan Sponsor
The CAP outreach effort provides Pharmacies
the discount Rx savings cards to
health care organizations* who
are on the front-lines of helping
people who are un-insured and
Individual Health Plan/
under-insured. with Rx card to Insurance
Company
fill prescription
* hospitals, clinics, emergency
departments, urgent care facilities,
mental health organizations, and
community non-profits. Outreach Effort-
Providing this resource
to hospitals, clinics, non-
profit orgs., etc.
Source: Report to the FTC; ―PBMs: The Basics and an Industry Overview‖ – The Health Strategies Consultancy, LLC 2003
8. In the Beginning…
Affordable Access Health Care Organizations (AAHCO) have long existed to
offer an affordable alternative to insurance.
AAHCOs network with doctors and dentists to establish non-insurance reduced
fee-for-service plans.
These plans are less costly than traditional insurance (but less comprehensive)
and can offer a viable solution to the un-insured and under-insured who are
challenged with obtaining or affording traditional insurance coverage.
Affordable Access
Health Care Organizations
(Discount fee-for-service plans
Discount medical for un-insured & under-insured) Discount dental
plans with plans with
discount discount
Rx medications Rx medications
9. A Helpful Resource During
Good Times and Bad
With the economic downturn, the need for assistance rose significantly for people who lost
their employer-sponsored health coverage when they were laid off or couldn’t find
employment. Private coverage was often too expensive and many employers reduced or
eliminated employee health coverage due to rising premiums, etc.
A few of the AAHCOs realized that the prescription savings resource they provide to their
fee-for-service plan clients could easily be made available, without cost, to people who were
un-insured and under-insured—independently of the medical or dental reduced fee-for-
service plans.
Since offering the Rx savings card resource for free didn’t require added cost to the
AAHCOs, nor any paperwork, enrollment or qualifications on the part of the card holder, it
made sense to make this prescription resource available, at no cost, to people who are un-
insured and under-insured. This inspired the establishment of the Community Assistance
Program, a collaborative grassroots outreach effort to help people access their medications
more affordably.
Affordable Access Discount dental Community Assistance
& medical Discount Program:
Health Care Organizations Outreach effort providing
plans with Rx Medications
this resource to
(Discount fee-for-service plans
for uninsured & under-insured) discount (Free Rx savings card) hospitals, clinics,
non-profit orgs., etc.
Rx medications
Figure 4. illustrates the evolution of the Rx savings card and outreach effort.
10. What is the “Community Assistance Program”?
Community Assistance Program (CAP) is the name of the grassroots
outreach effort to provide the Rx discount resource to hospitals, clinics and
other health care-related groups.
This outreach effort grew it’s legs at the beginning of the economic
downturn with the specific intention of offering these prescription savings
cards to medical professionals on the front-lines of helping people
in need including:
Case Managers
Social Workers
Clinics
Emergency Department
Mental Health Facilities
Non-profit Organizations
Rx
11. Community Assistance Program (CAP) Further Explained
CAP is a collaborative effort between various groups dedicated to
affordable access to healthcare.
Because CAP collaborators already offer the HealthTrans® Rx savings
card to their medical and dental reduced fee-for-service clients, there is no
additional cost—other than postage—for them to provide this helpful
prescription resource to your organization.
CAP is a way for these healthcare access groups to lend their support to
people who are un-insured and under-insured.
Providing the HealthTrans® Rx savings card resource to the people you
serve does not promote or endorse any of the organizations involved in this
grassroots outreach effort.
13. Q: Is the Community Assistance Program a ―program‖
that we have to enroll in? Are we required to do anything
when we receive the Rx savings cards?
A: There are no enrollment requirements in order to
recieve, utilize, and benefit from the Rx savings cards.
Community Assistance Program is just the name of the outreach effort. It is
not a formal ―program‖ that requires sign-ups, qualifications, or paperwork.
This applies to both the organization receiving the cards and the individual
card user. The Rx savings cards are ready for immediate use at most
pharmacies nationwide.
An organization such as a hospital or clinic receiving the cards are not
required to do anything when distributing the resource.
Although we hope you take advantage of this valuable
resource, it’s purely voluntary for you to provide the
Rx savings cards to people in need.
14. Q: Should we be aware of any promotion or endorsement
of a vendor, company or pharmacy when providing these
Rx savings cards to the community we serve?
A: With this Rx savings card there is no promotion or
endorsement of any organization, company or
pharmacy when providing it to those in need.
Note the HealthTrans logo on the front of the CAP Rx savings card:
This logo is needed to assist the pharmacy so they know what appropriate
discount to apply.
As noted on previous slides, HealthTrans® is the pharmacy benefit manager for the Rx
savings cards used in this outreach effort.
HealthTrans® has a solid reputation, with the highest rating with the BBB* and an
extensive network of pharmacies that they are contracted with. This enables them to
establish discounts on meds that are higher than average drug pricing discounts.
* www.bbb.org/denver/business-reviews/health-care-management/healthtrans-in-greenwood-village-co-90020054
15. Q: Who are you providing these Rx savings cards to as a
part of the CAP outreach effort?
A: There many types of organizations that have expressed the need
for the Rx savings card to help those they serve. These include:
Hospitals Community Centers
Clinics Religious Groups
PCPs Weight Loss Clinics
Mental Health Facilities Assisted Living Facilities
Here’s a list of a few organizations actively providing the CAP Rx discount card to
their patients:
• The USDA • Bright Star Missionary Baptist Church
• InsureEasyLife.com • Forgotten Harvest
• LUPE • Bayada Nurses Home Care Specialists
• General Federation of Women’s Clubs • All Medical Resource Foundation, I
• New Jersey Chamber of Commerce • International Technologies Medical Lab Svcs.
• C.A.L.I.F. (Community Actively Living Independent & Free)
16. Q: What kind of savings do people experience when they
use the CAP/HealthTrans® Rx savings card?
A: When someone with a valid prescription presents the
HealthTrans® Rx savings card at a participating
pharmacy, they can save on average:
15% on Brand Name Drugs
55% on Generic Drugs
Savings range from 10% to 85% off all prescription drugs.
The card can be used over and over again and it never expires.
Note: Privacy of card user is protected and
no personal information is gathered at time of use.
17. Q: Is there a cost to get this resource for our organization?
A: There is no cost to
receive the CAP
Rx savings cards.
Through a grassroots outreach effort
called Community Assistance
Program, we have the ability to
provide this resource to your
organization for free.
18. Q: After we run out of our first batch of Rx savings
cards, can we continue to request more from you?
A: Absolutely! Our goal is to
provide this resource to any
organization that has a need for it
on an ongoing basis.
Feel free to request additional
Rx savings cards at any time.
Other translations of the Rx
savings cards are available.
(see slide #32)
19. Q: What prescription drugs can a person get discounts
on using the Rx Savings Card?
A: All FDA approved prescription drugs are eligible
for a discount with the Rx savings cards—name-
brand and generic.
Smoking cessation meds, psychotropic
meds and diabetes supplies can also be
obtained at greatly reduced rates.
20. Q: Does it cost a card holder anything to use the Rx savings
card at a pharmacy and receive discounts on prescription
medications?
A: The Rx savings card is free to use at any
participating pharmacy.
The card user is responsible for paying the discounted
price of the prescription medication(s) once the card has been
presented.
Note: Multiple medications can be filled at the same time using one
Rx savings card and it can be used over and over without expiration.
21. Q: Is the number of pharmacies that accept the
Rx savings card limited?
A: Not at all. Over 80% of pharmacies nationwide and
US territories accept the HealthTrans® Rx savings card.
Many well-known pharmacies that participate are:
CVS • Walgreens • Rite-Aid • Wal-Mart • Target • Kroger
K-Mart • Longs Drugs • Safeway • Osco • Sav-On • Ongs Albertsons
Sam’s • Winn-Dixie • Costco • Brooks • Stop & Shop • Medicine Shoppe
Duane-Reade • Heb • Meijer • Hy-Vee • Giant • Raley's • Shopko • Bi-Lo
Smiths • Pathmark Fred Meyer • Aurora • Pamida • Fry's • Kings
ShopRite • Hannaford • Tops • Weiss • and many more...
* Many local independent pharmacies accept the card too.
Simply go to: www.USMedSavings.org to find a
participating pharmacy in your area.
22. Q: Is there any paperwork or pre-qualifications in order for
someone to use the Rx savings card?
A: Absolutely None
The Rx savings card is a ―bearer card‖ meaning anyone
presenting the card at a participating pharmacy can receive a
savings.
Additionally, there is no gathering of any personal
information at time of use—not even the person’s name.
23. Q: Will a discount be given every time the
Rx savings card is used?
A: A person using the card will get a discount
approximately 94% of the time.
The reason it is not 100% of the time is
that, from time to time, pharmacies price certain
drugs at ―cost‖ to attract customers to their
stores.
In this type of situation the cardholder would get
the lowest price.
Average Savings: 15% on Brand Name and 55% on Generics.
24. Q: How will the Rx savings card holder know if they’re
getting a discount?
A: An Rx savings card user can go to
www.USMedSavings.org and look up what
the price of their drug is at their local
pharmacy. (see slide #27 of this presentation)
-or-
The Rx savings card user can ask the
pharmacist at the time of purchase how much
of a discount they received using the card.
An entire household can use one Rx savings card. The card can
be used over and over again & does not expire.
25. Q: Can the HealthTrans®/CAP Rx savings card
be used with insurance?
A: Yes and No. If someone has Rx insurance, but their medication
falls outside of what’s covered by their Rx insurance formulary, then
the Rx savings can be used. However, it cannot be used to receive a
discount on an insurance co-pay.
Here are some situations where the card can be used alongside Insurance:
Limited Formularies – Insurance companies are
increasingly limiting which drugs they will pay for. The Rx
savings card can be used to receive a discount when a
medication is not covered. For example: birth control,
diabetic supplies, smoking cessation, and other types of
drugs that the insurance company decides are not cost
effective for them.
High deductible plans – The Rx savings card can help
people reduce the cost of their Rx meds while they are
within their plan’s deductible limit and are required to pay
100% out-of-pocket for their prescriptions.
26. Q: Can someone use the Rx savings card even if they
have Medicare or Medicaid (Medi-Cal)?
A: Yes, the Rx card can be used alongside these plans. For example:
Medicare – The Rx card can be used when someone has
Medicare, but is not enrolled in the Part D prescription coverage plan.
Medicare Part D – The Rx savings card can be used to secure discounts on
those drugs that are excluded from Medicare Part D. It will also provide discounts
when a person on Medicare reaches the ―donut hole coverage gap‖.
Excluded coverage for medications treating certain conditions under Medicare
Part D: Anorexia, weight loss, weight gain, fertility, hair growth, supplemental relief
of cough, Rx vitamins, and sleep aids.
Medicaid and Medi-Cal – The Rx card can be used when a
medication falls outside of the set formulary under these programs.
An increasing number of people are experiencing this problem
due to recent cutbacks in these programs at the state level.
28. To locate pharmacies that accept the Rx Savings Card,
follow these steps:
1. www.USMedSavings.org (Must type into address bar at top of screen)
2. Click on the Drug Pricing & Pharmacy Look Up link button on the Home Page.
3. Click on Pharmacy Locator as shown here:
You will come to a web site similar to the image below…
(Chose “By Distance…” or “By Pharmacy” then enter city, state, zip code and distance
of the pharmacies you wish to search as shown below and click the “Go” button)
(Go to following slide for search results)
29. Search results of pharmacies that accept the
Rx savings card within a specific city.
30. To price the discounts on medications using the
Rx savings card, follow these steps:
1. www.USMedSavings.org (Must type into address bar at top of screen)
2. Click on the Drug Pricing & Pharmacy Look Up link button on the Home Page.
3. Click on Rx Drug Pricing as shown here:
You will come to a website similar to the image below…
(Enter the name of the medication in the “Drug Name” box as shown below and click the “Go” button)
(Go to following slide for search results)
31. Pricing the discounts on medications using
the Rx savings card, continued…
1. Click the circle left of on Rx dosage you wish to price (see ).
(See following slide for additional steps)
32. 2. After choosing Rx dosage wait a few seconds for the script
details to appear as shown below and enter info.
3. Click the ―Price Drug‖ box to price the prescription med.
(See following slide for pricing results)
33. Example, here are the pricing results for name-brand Zocor and its generic
version, Simvastatin using the HealthTrans®/CAP Rx savings card at
Walgreens Pharmacy in the 78205 zip code:
34. Here are pricing results for name-brand Zocor and its generic
version, Simvastatin using the HealthTrans®/CAP Rx savings
card at various pharmacies in the 78205 zip code:
CVS Pharmacy
343 W Houston St Zocor 40 Mg Tablet 30 tablets: $164.68
San Antonio, TX Simvastatin 40 Mg Tablet 30 tablets: $53.20
Trinity Rx #3
700 S Saint Marys St Zocor 40 Mg Tablet 30 tablets: $164.74
San Antonio, TX Simvastatin 40 Mg Tablet 30 tablets: $10.86
M and S Tower Pharmacy
730 N Main Ave Zocor 40 Mg Tablet 30 tablets: $165.93
San Antonio, TX Simvastatin 40 Mg Tablet 30 tablets: $11.36
NOTE: This price comparison is not an endorsement of one pharmacy over
another, it’s just an example of how the Rx Pricing tool can really help your
patients save even more. We appreciate how busy you are. These are
just tools that you can use at your discretion.
35. The Rx savings cards can be translated
in other languages!
Arabic • Armenian • Farsi • Hmong • Khmer • Korean • Mandarin • Russian • Somali • Spanish • Tagalog • Vietnamese
36. Q: Are there other resources
available through CAP?
A: There are TWO supplemental programs
available:
1) A prescription assistance program called Rx Med Assist
that can reduce the price of expensive prescription
medications.
2) CAP Diabetic Program to reduce the cost of testing
supplies for diabetics.
37. What is Rx Med Assist?
Rx Med Assist is a Prescription Assistance Program (PAP). PAPs date back to the
1950s when the U.S. government created incentives for pharmaceutical companies to
help uninsured and under-insured Americans receive low-cost or free prescription
drugs.
While PAPs are run by pharmaceutical companies, without a resource like Rx Med
Assist, the enrollment process can be complicated and overwhelming to patients.
Rx Med Assist simplifies the enrollment process for people who have no public or
private prescription drug coverage and struggle to pay for their monthly maintenance
medications
How does Rx Med Assist help patients?
Informs and educates patients about the Handles all annual reapplications for the
options that best fit their needs. patient.
Accesses, completes and processes all If patient is eligible, the cost of each
required forms. qualifying medication is reduced to $20
per month.
Reviews over 250 programs that may
help the patient save on their prescription
meds.
38. What guidelines must be met in order to
quality for Rx Med Assist?
Medication must be offered through a Annual Income Eligibility Guidelines for 2012:
Prescription Assistance Program (PAP).
Family Size Annual Gross Family
Income Limits
Income eligibility guidelines apply 1 $27,225
depending on total family members (see 2 $36,775
chart). 3 $46,325
4 $55,875
5 $65,425
Applicant cannot be covered by private 6 $74,975
prescription coverage, Medicare Part- 7 $84,525
D, or Medicaid (Medi-Cal). (some 8 $94,075
exceptions may apply) For each additional $9,350
family member
Please call us at 866-889-1662 to learn more about the program
- or - visit www.usmedassist.org for additional information or
to submit an application.
39. What is the CAP Diabetic Program?
CAP Diabetic Program is a supplemental resource provided through the
Community Assistance Program (CAP) for discounted diabetic testing
supplies (mail-order) for the uninsured and under-insured.
The savings through the program average 50% off retail, over-the-counter
pricing of diabetic testing supplies received through mail-order.
Monthly retail pricing for test strips: The program includes the following:
• $29.99 test once daily Free glucose meter
• $41.99 test 2 times daily Free lancing device
• $43.99 test 3 times daily Free monthly ultra-thin lancets
• $56.99 test 4 times daily Free carrying case
• $58.99 test 5 times daily Free monthly shipping
• $69.99 test 6 times daily Free Rx discounts (provided
• $78.99 test 7 times daily through the CAP Rx savings card)
• $86.99 test 8 times daily
• $94.99 test 9 times daily
40. How do you enroll in the CAP Diabetic Program?
There are three easy ways to enroll:
1. Complete the easy online form at www.CAPDiabeticProgram.org and
submit it electronically.
2. Call 1-888-983-7829 & mention group ID 1117 to speak with a friendly customer
representative who will assist you with enrollment.
3. Go to www.CAPDiabeticProgram.org and print an enrollment form to fax or
mail in.
Frequently asked questions:
How does the program work?
Upon enrollment, you will be electronically debited monthly from your checking account
or credit card for everything you need to test your blood glucose levels monthly. Supplies
will be shipped right to your door.
Are there any upfront fees, cancellation fees or long-term contracts?
No, the program is month-to-month and you can cancel at any time without penalty.
Call us if you have any questions
about this program: 866-889-1662
41. Community Assistance Program
Making healthcare more affordable
Please call or email us if you have any questions or
if you would like to receive a free supply of Rx savings cards
for your organization.
1-866-889-1662
www.USMedSavings.org
info@usmedsavings.org
www.facebook.com/communityassistanceprogram