Rx Mole Blog

This article accompanies HR Problem Solvers for 2010 .

By Michael O’Brien

The impetus behind Rx Mole, a free website designed to help workers lower their healthcare costs, lies in a quotation from 19th-century American writer Albert Pike found on the site: “What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.”

Bryan Jackson, site HR manager for Terre Haute, Ind.-based plastic-film manufacturer Applied Extrusion Technologies Inc., launched the site in May 2009 in conjunction with local pharmacies after his company switched to a high-deductible health plan with a health-savings account, and employees began complaining that they couldn’t get credible information on prescription drugs without spending a lot of time searching.

While the original website was intended to help employees find the cheapest prices for prescription drugs, once the project began to take shape, it was evident that the real value for members was in information sharing on “cash price” for drugs and in developing relationships with local pharmacists, Jackson says.

The site is hosted by a third party, not the company, in an effort to provide a layer of privacy protection for employees who use it. “We want it to be open and transparent,” Jackson says. “The more information people put in, the better off everyone will be. Employees at other organizations can use it; people who don’t have insurance can use it.”

The site is now in its fourth iteration and eventually will have a mobile-phone application. “It’s all for the greater good,” says Jackson. “We’re not looking to make a lot of money … . We just want to help out our employees, as well as employers who struggle with healthcare costs.” Albert Pike would appreciate that.

Applied Extrusion Technologies Inc., Terre Haute, Ind.

Read all of the 2010 HR Problem Solvers .

Posted via Quinn’s Commentary.

Take your pick, various sources calculate that 16% , 14% or less than 10% of Medicare beneficiaries reach the “donut hole” under Medicare Part D. Regardless of which number you use, the vast majority of Medicare beneficiaries never reach the now disappearing donut hole. Yet to hear the politicians tell the story, elimination of what amounts to an internal deductible is the greatest thing since sliced bread. Hey, if we could afford it, I am all for making needed prescriptions free, but we can’t afford that and there is no such thing as free in any case.  (Click here for more…)

Posted via Enabling Health Decisions

I’m surprised this took the 3 years to play out. I talked about this back in 2007. Today, Walgreens announced that they would no longer participate with CVS Caremark networks for new networks and renewals. (See the CVS Caremark response here.)

Personally, I’m a little surprised they didn’t limit it just to the Maintenance Choice contracts which is where they have issues (like Mandatory Mail). Walgreens has fought for years against PBMs that implement models that limit choice. (Click Here for more…)

A great blog to follow is Drug Channels.  Dr. Fein recently published his annual report explaining the relative profitability of the largest drug wholesalers, chain pharmacies, and pharmacy benefit managers (PBMs).  A copy of the report can be found here.

Rx Mole is a service that helps members establish a relationship with a pharmacist and allows members to submit prescription drug prices confidentially.

We recently implemented a program called Top 5 Notify .  At Rx Mole members can create a “Top 5″ drug list.   In addition, members can now create a “favorites” list of their favorite pharmacies.

When a price is updated for a drug on your Top 5 List at one of your favorite pharmacies, Rx Mole will notify you of this change via email.  Top 5 Notify is a program that makes tracking prices on prescription drugs easy!

Rx Mole is the only website that allows members to network in a confidentially and securely with pharmacies and other members.   Sign up today.

Great blog to follow is quinnscommentary.  Here is a great post and something you don’t hear at the podium.

What the CBO Director says about the impact of health care reform on the deficit

The new Express Scripts Drug Trend Report is out.  The report is geared to give consumers a look at trends happening in the pharmaceutical industry and predict future trends.  We follow a number of blogs that look a these types of trends. Enabling Healthy Decisions is one that we recommend to keep up to date on this report and other reports submitted by PBM’s.

The report is in PDF and can be downloaded off of the website.  Here is an excerpt.

There is currently $163 billion in pharmacy-related waste in America due to behavior. Express Scripts is uniquely positioned to turn this behavioral waste into savings and drive positive clinical behaviors through Consumerology® — the advanced application of the behavioral sciences to healthcare.
Report Highlights Include:

• After years of lower drug trend increases, overall drug trend is increasing at a greater rate.
• Key drivers are cost per unit and increases in utilization.
• By focusing on the “big three” of behavioral waste – drug mix, channel, and therapy adherence – plan sponsors can realize substantial savings for themselves and their members across both the pharmacy and medical benefits.
  

We started this project in March 2009.  It has been a long journey and many hours of programming, meeting, talking, brainstorming ect.  It hasn’t been without frustration and much satisfaction.

With this I am happy to say that Rx Mole version 4 has been released and while we are still in beta (probably forever at the rate we are going) we are making some very good headway and progress.

So, “What has changed?” you ask?  Well for starters we have better refined the purpose of the site.  Rx Mole is about 2 things:

1. Establishing a relationship with a trusted local pharmacist.
2. Efficiently finding the best cash price on prescription drugs.

We met with a number of independent pharmacists over the past few months and have come to find a better appreciation for the profession and their dedication to helping people live healthier lives.  In these meetings we have learned that cost is a very small component of the prescription drug equation.   As many of you know, I work in the human resources field.  Over the past few years we have encouraged our employees to establish a close relationship with their doctor, ask questions, become informed and better consumers of health care.  One component that we missed is a relationship with a pharmacist.  Over the past few months I have had the pleasure to speak with some of the smartest people I have ever met.  Lynn, John and Ron are all top rate pharmacists and genuinely care for their customers and their health.  They are looking out for their customers to make sure they are taking healthy doses and not paying for overpriced brand name drugs if generics are available.  They pride themselves on knowing their customers on a first name basis and establishing relationships that matter for the greater good.

Rx Mole will further encourage this relationship by enabling our members to get to know the pharmacy and pharmacists through media such as online profiles, blog posts and online questions and answers.  Rx Mole has updated the site with the following

• Members will have an opportunity to ask prescription questions  to local pharmacists that they know or have heard of.  In turn the pharmacists can answer these questions and then better know these potential customers.  The questions and answers are then tracked on the Rx Mole site for all members to search and view.
• Pharmacists will have the opportunity to post blog articles.  It has been my experience that many pharmacists are a wealth of knowledge when it comes to compounding, natural remedies, and generic equivalents.  They typically are not influenced by the “drug of the month”.
• Pharmacies will be able to create profiles on the site that include information about store hours and pharmacist information.  In addition members can rate the pharmacies and leave comments about experiences they have had.

In our previous version of Rx Mole we focused solely on prescription drug prices.  These prices would vary by insurance provider, drug plan, medical type or employer plan.  There were a million variables that confused the process and prevented us from really comparing “apples to apples”.  Additionally the pharmacies don’t really have any say in the prices they sell their drug at.  Insurance dictates their selling margins and at what price they sell the drugs, thus taking away any market competitiveness.  This is where cash price comes into play.  Many times (especially on generic drugs) by asking for cash price (not using insurance) you can get a better deal on prescription drugs.  Why?  Well by going outside the insurance company control the pharmacy can sell drugs at whatever price they see fit.  Thus  true market conditions can apply.  Additionally if you do have insurance, you can normally submit a manual claim with your insurance company (keep your receipt)  for reimbursement or have it go toward your deductible (if applicable).  So always ask for CASH PRICE!  Rx Mole has updated to help on cash price by enabling members to enter cash price for drugs they take.  Additionally the pharmacies can enter their prices into the system as well.

We added an employer section as well to the site.  As an HR professional, I am always knowledgeable of the top drugs my employees take.  The insurance company tells me all of this information, but honestly I believe the data to be biased to show “how good they are”.  Employers will be able to determine information from Rx Mole only if users identify them as their employer (this is optional for the user).  Additionally, if an employer doesn’t have at least 50 users in the database then the information will only show user data for the surrounding area.  This is to protect user confidentiality.  Rx Mole will show employers the following:

• What are the top drugs for your employees?
• Where are your employee’s favorite pharmacies?
• What are the latest questions asked by your employees?
• Where are the best local prices on your top 10 drugs used by your employees?
• Which pharmacies get the highest marks in your area?

As you can see there are many exciting things happening on this site.  We are proud of where we have gone and look forward to seeing where this journey will take us.

Bryan Jackson is an HR professional and founder of Rx Mole.  He can be reached at bjackson@rxmole.com

CVS Caremark’s questionable conduct following the 2007 merger of retail juggernaut CVS (7,000 stores) and pharmacy benefit manager Caremark (2nd largest PBM) continues to raise concerns among patients, community pharmacists and federal and state policy makers – documented most recently by Fortune. There is so much activity, you almost need a scorecard to keep up.
Federal Trade Commission
The Washington Post reported that the Federal Trade Commission is officially investigating CVS Caremark’s business practices. NCPA and others have provided the FTC with many examples of CVS Caremark misconduct. The FTC staff also heard from two Detroit-area pharmacists on the verge of losing their businesses as the result of abusive audit practices by CVS Caremark.
A February 2010 report in The Washington Post chronicles bipartisan concern in Congress about CVS Caremark. The lawmakers support an FTC investigation of the company.
Separately, Dow Jones reported that the FTC’s recent requirement of a firewall as part of Pepsi Co’s acquisition of two large bottlers would restrict access to sensitive business information, and could serve as a model for policing CVS Caremark.
Already, CVS Caremark agreed to pay $2.25 million to resolve FTC charges of HIPAA privacy violations.
Congressional Action
A House subcommittee recently approved a bill introduced by U.S. Representative Stephen F. Lynch (D-Mass.) to allow the Office of Personnel Management to increase regulation of pharmacy benefit managers, such as CVS Caremark, contracting with the Federal Employees Health Benefits Program (FEHBP). Among other fixes, Rep. Lynch’s bill would prohibit a PBM from switching a patient’s drug, which can drive up costs, without a doctor’s approval and ban the FEHBP from doing business with PBMs that own both retail and PBM pharmacies – an obvious conflict of interest. FEHBP members experienced drug cost increases of 69 percent over the last eight years. A startling report by Change to Win determined that FEHBP enrollees covered by CVS Caremark pay more at CVS pharmacies than uninsured patients do on 85% of generic drugs.
Senate Finance Committee Ranking Member Chuck Grassley (R-Iowa) is asking PBMs like CVS Caremark about their financial relationships with pharmaceutical manufacturers. Critics allege that as much as 50% of manufacturer rebates are kept by PBMs, driving up costs to plan sponsors and patients while encouraging profit-based coverage decisions. The Medicare Payment Advisory Commission has called for a national disclosure requirement for PBMs.
Medicaid Fraud Probe
In January 2010 CVS Caremark received a federal subpoena as part of an ongoing investigation into potential false or improper Medicaid claims by the Department of Health and Human Services’ Office of Inspector General. The subpoena requested claims data for dual eligible CVS Caremark’s questionable conduct following the 2007 merger of retail juggernaut CVS (7,000 stores) and pharmacy benefit manager Caremark (2nd largest PBM) continues to raise concerns among patients, community pharmacists and federal and state policy makers – documented most recently by Fortune. There is so much activity, you almost need a scorecard to keep up.
Federal Trade Commission
The Washington Post reported that the Federal Trade Commission is officially investigating CVS Caremark’s business practices. NCPA and others have provided the FTC with many examples of CVS Caremark misconduct. The FTC staff also heard from two Detroit-area pharmacists on the verge of losing their businesses as the result of abusive audit practices by CVS Caremark.
A February 2010 report in The Washington Post chronicles bipartisan concern in Congress about CVS Caremark. The lawmakers support an FTC investigation of the company.
Separately, Dow Jones reported that the FTC’s recent requirement of a firewall as part of Pepsi Co’s acquisition of two large bottlers would restrict access to sensitive business information, and could serve as a model for policing CVS Caremark.
Already, CVS Caremark agreed to pay $2.25 million to resolve FTC charges of HIPAA privacy violations.
Congressional Action
A House subcommittee recently approved a bill introduced by U.S. Representative Stephen F. Lynch (D-Mass.) to allow the Office of Personnel Management to increase regulation of pharmacy benefit managers, such as CVS Caremark, contracting with the Federal Employees Health Benefits Program (FEHBP). Among other fixes, Rep. Lynch’s bill would prohibit a PBM from switching a patient’s drug, which can drive up costs, without a doctor’s approval and ban the FEHBP from doing business with PBMs that own both retail and PBM pharmacies – an obvious conflict of interest. FEHBP members experienced drug cost increases of 69 percent over the last eight years. A startling report by Change to Win determined that FEHBP enrollees covered by CVS Caremark pay more at CVS pharmacies than uninsured patients do on 85% of generic drugs.
Senate Finance Committee Ranking Member Chuck Grassley (R-Iowa) is asking PBMs like CVS Caremark about their financial relationships with pharmaceutical manufacturers. Critics allege that as much as 50% of manufacturer rebates are kept by PBMs, driving up costs to plan sponsors and patients while encouraging profit-based coverage decisions. The Medicare Payment Advisory Commission has called for a national disclosure requirement for PBMs.
Medicaid Fraud Probe
In January 2010 CVS Caremark received a federal subpoena as part of an ongoing investigation into potential false or improper Medicaid claims by the Department of Health and Human Services’ Office of Inspector General. The subpoena requested claims data for dual eligible

Had enough?  Where there’s smoke … there’s fire!

I have updated the theme of Rx Mole to better encourage collaboration and information sharing. The buddypress theme platform is looking promising.