I’m asked this question all the time. If our solution is so good and helps make medication affordable for so many people, why not make it accessible to every consumer? We wish we could.
We think about it every time a member tells us how much they’re saving, how they were able to resume important therapy, or how grateful they are to have a financial burden lifted. We want to do the same for everybody who needs help.
There’s one problem, though. It’s the data our solution needs to work its magic—or rather, the access to that data.
Take pharmacy claims. A person’s individual prescription history is theirs, but their health plan owns the data, along with that of everyone else’s in the plan. And it’s all protected by the Health Insurance Portability and Accountability Act (HIPAA).
There are formularies for every plan too, which dictate pricing tiers and preferences for all the medications a plan chooses to cover. Pharmacy benefit managers (PBMs) negotiate different pricing and tiers, as well as preferred pharmacy arrangements, all of which affect a drug’s price for members in a given plan.
Deductibles also impact the price paid at the pharmacy, and every person’s deductible amount and status can change with every prescription fill. This is where a plan’s accumulator data comes in, determining which drugs and how much of their cost can be applied toward a deductible.
Since every plan is different, the price any individual will pay for the same prescription can vary dramatically. Our solution figures it all out for our members in seconds. But it can’t for a random consumer—not without all the data from that person’s health plan, PBM and other sources. Remember, it’s all protected health information, and it must travel through HIPAA-compliant channels.
We want to build and deliver only the best, most effective solution possible. We want to make it accessible to the most people possible. That means partnering with employers and health plans. Without them, our solution would be sub-par and reach fewer people. That would be unacceptable to me and everyone at Rx Savings Solutions.
Unfortunately, in the richest nation in the world, we’re forced to work through such a complex system with opacity throughout the pharmaceutical supply chain. We believe our solution is helping to change that.
We’re happy that more than 4 million American consumers can use it. We’ll get to 250 million someday. You can help by asking your employer or health plan to give you Rx Savings Solutions.