Making the right decisions about Rx Plan Design is critical to controlling costs and avoiding member disruption. WellNet’s staff are experienced in constructing plans that meet a company’s specific requirements for member copays, drug coverage and pricing tiers. WellNet’s Client Account Managers and Advisory Consultants work with our clients from implementation and throughout the year to offer insight into best practices and assist in evaluating the alternatives in Rx Plan Design to ensure the most appropriate plan decisions for their member population and the company are being made.
Carrier Alternatives
WellNet currently offers Rx plans leveraging the CVS/Caremark and Catalyst carrier networks. Both carriers offer extensive pharmacy networks, mail order capabilities and excellent drug coverage models to serve WellNet’s clients and members. WellNet assigns clients to a carrier based on their ability to meet the company’s and member’s needs. The key areas of divergence in the offering of the two carriers are in:
- Drug Coverage (Formularies)
- Brand Dispensing Policy
Drug Pricing (Formularies)
Prescription drugs are classified into one of the following three categories:
- Single Source Brand (SSB)
- Multi Source Brand (MSB)
- Generic
Rx carriers map drugs to these categories and apply a formulary which tiers the drugs into copay brackets. When a carrier’s formulary is used in conjunction with an Rx plan summary, a member can determine the expected copay they will incur when filling a prescription for a particular drug.
Brand Dispensing Policy
In addition to copay tiering of prescription drugs, Rx carriers also establish policies regarding the maximum allowable coverage for brand name prescription drugs with generic equivalents. These policies assist companies in incenting the most cost effective behaviors of their members by disincentivizing the often medically unnecessary use of brand name medications.
For detailed information regarding WellNet’s Rx carrier partners click the appropriate link below:
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Point to Point's Active Reporting system is highly informative on a real-time basis and has helped me save $238,000."
Vice President of Human Resources
University
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"For the first time, we’re catching problems before they become catastrophic. WellNet’s the type of partner that’s proving that they’re able to drive down medical costs."
Consultant
Mid and large size businesses
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Vice President of Human Resources
Hospital facility
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We have saved $850,000 by using WellNet’s Point to Point technology. Medical expenses are lower, but the level of coverage is not and members are not paying more. WellNet provides valuable information that is understandable and they provide effective turn-key strategies to lower claims over the long term."
Director of Human Resources
School District
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Chief Executive Officer
National Nursing Home Chain
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Every single service representative we work with at WellNet is outstanding! Their advisors' responsiveness, knowledge and caring attitude are the best we have seen in the business – and we have seen a lot!"
Director of Employee Benefits
Hospitality firm
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"It makes complete sense to correlate the Rx usage with the medical plan. With WellNet we can now monitor this and make better proactive decisions based on what the data tells us."
Vice President of Human Resources
Financial Magazine
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"Having data analyzed and interpreted will help in planning for the next 3 to 5 years out, which every CEO needs to do. Any growing company needs to be thinking about all of their healthcare benefits; having this kind of data allows us to manage our 3rd biggest expense as we approach all of our other business units."
Chief Executive Officer
Manufacturing firm
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"What haven’t you included in here? If I understand correctly, there’s no piece of data or healthcare service that’s not included here. This is brilliant."
Senior Vice President of Human Resources
National and Regional non-Profit
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"I have got to tell you that you really ’WOWED’ all of us, not only with the extent, usefulness and volume of data but also with Point to Point’s ability to present and interpret. We view your technology as an extremely useful tool."
Employee Benefits Manager
87 location Mid-Atlantic Bank
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