PCA RX Company Overview

1. Company Overview

2.  Prescription Corporation of America (PCA)
is a rapidly growing Pharmacy Benefit Manager (PBM)
located in Denville, New Jersey.
 Since launching operations in January 2011, we have
added over 80 private and public sector clients.
 PCA has created a pharmaceutical pricing, delivery and
systems model that benefits plan sponsors and patients,
rather than prescription drug program administrators.
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3. PCA’s mission is to reduce and control
prescription drug costs for our clients,
while improving the quality of care for the
members and families we serve.
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4.  Retail Pharmacy Prescriptions
 Mail Order Home Delivery Service
 Patient Empowerment Program (PEP)
 Prescription Discount Cards
 Non-Profit Drug Programs
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5. Service Highlights – How PCA
accomplishes its mission
 Expert benefit management, plan design, and cost control
 Efficient retail claims processing within our nationwide network
of 64,000+ pharmacies
 Ability to guarantee claim rates through reinsurance
 24/7/365 Customer Service where you speak to a real live
person who has a personalized focus on your members and
their families
 Mail Order Home Delivery Service from our Denville, NJ
pharmacy
 Patient advocacy and education
 Business model firmly based on transparency and proactive
benefit cost management
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6. PCA administers plans for many types of clients:
 Commercial clients including employer groups of varying sizes in a broad range of
industries
 Business associations, chamber of commerce organizations, and trade groups
 All levels of government entities (towns, counties, and school boards)
 Labor groups, unions, welfare funds, and Taft Hartley plans
 Charitable organizations and other qualified non-profits
with over 23,000 union members
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7. PCA Programs
 Self Insured – our relationship with reinsurers allows us to offer guaranteed claim rates,
along with full transparency and 100% return of manufacturers’ rebates.
 Fixed Cost –
access to reinsurance enables us to offer the most effective fixed cost,
capitated, fully funded plans.
 Rx $avings $olutions – these affordable plans feature generic only or generic and
preferred brand formularies, allowing us to provide lower cost alternatives than our
competitors.
 PCA Prescription Savings Card – this program enables members and their families
to realize savings of 15% to 75% on prescription drug purchases through a nationwide network
of over 62,000 pharmacies.
 Patient Empowerment Program (PEP) this voluntary clinical management –
program provides members with a CASH incentive to try brand-to-generic substitutions and
therapeutic brand alternatives.
 PCA Non-Profit Drug Program – allows non-profits to purchase medications at the
lower cost hospital acute care “Class of Trade” rate.
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These programs are complimented by our formulary management, clinical programs (including
Medication Therapy Management (MTM) and Step Therapy), 24/7/365 live customer service, and
consultative services focused on opportunities to maximize savings.
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8. Our Competitive Advantages
While PCA’s growth allows us to leverage major alliances and
relationships with pharmaceutical manufacturers, we remain focused on
personalized customer service for our clients and members.
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 Lower Program Costs - As a true client advocate, PCA’s programs, plan
designs, and pricing achieve the lowest drug program costs without sacrificing quality
of care.
 Reinsurance – Our alliance with reinsurance providers allows us to guarantee
savings, or administer effective fixed cost plans.
 Consultative and Administrative Services – PCA will help you select
your formulary and plan design from our many options. Our analytic and reporting
tools, combined with our expert analysis, will maximize your savings opportunities.
 Our Pharmacy Network – PCA’s network features over 64,000 pharmacies
nationwide. We also have a Preferred Network option with over 20,000 pharmacies
allowing for deeper discounts.
 Claims Processing - Our partnership with Argus Health Services provides
state-of-the-art electronic claims adjudication capabilities. Argus currently processes
over 500 million pharmacy claims a year.
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9. Mail Order Home Delivery
PCA’s Mail Order Home Delivery
Pharmacy is located at our
Denville, NJ headquarters and
designed to take advantage of
the lowest purchasing prices
available, allowing us to pass
along these savings to our
clients and members.
Unlike other PBMs that have
outsourced mail order
arrangements, PCA’s pharmacy
facility is operated by our in-
house pharmacy team. Your
plan members can access all
the details of this program and
get started through our website
at www.hca-pca.com.
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10. Customer Service
PCA’s multi-lingual, 24/7/365
live customer service capabilities
for providers and members
feature personalized service
tailored to your plan design. We
deliver "real-time" access to plan
information and out-of-pocket
expenses, as well as clinical
information on the proper
utilization of medications.
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11. www.hca-pca.com
PCA continues to
develop our user-
friendly website,
www.hca-pca.com,
with the latest
information on our
programs and
formularies, our
Mail Order Home
Delivery Program, a
pharmacy locator,
the ability to price
and compare
medication costs,
clinical programs,
and updates on new
PCA initiatives.
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12. PRIOR
AUTHORIZATION
COST-OVERRIDES
RETAIL $45,467 RETAIL (GENERIC
(THERAPEUTIC SWITCH)
SWITCH)
$2,027,989 $646,611
PCA MAIL-ORDER
ANNUALIZED PCA MAIL-ORDER
(THERAPEUTIC
(GENERIC SWITCH)
SWITCH)
$2,830,369 $6,046
$104,254
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13. Here are a few examples of recent results:
 Regional High School with 500 employees:
11% savings based on insured renewal of fixed-cost program
with 12 month rate guarantee.
 New Jersey County with 3,400 employees:
$546,000 in guaranteed savings for self funded program based
on hard-dollar claim cost reduction.
 Non-Profit Association with 33,000 members:
18-55% savings on prescription purchases with discount
savings card provided free of charge to all members.
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14. PCA Savings Illustration
 Regional High School with 500 employees:
Fixed-cost program with twelve-month rate guarantee
and 9.88% savings based on insured renewal.
Enrollment Incumbent PCA
Annual Annual
Rates Premium Rates Premium
Single $134.28 $273,931 $121.02 $246,881
Parent & Child(ren) $288.12 $107,181 $259.66 $96,594
Two Adults $319.94 $345,535 $288.34 $311,407
Family $385.92 $879,898 $347.81 $793,007
Dependents Age 26 – 31 $81.64 $16,655 $73.58 $15,010
Annual Fixed Cost $1,623,199 $1,462,899
Percentage Savings 9.88%
Total Dollar Savings $160,301
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15. Basic Survey
Here are the initial questions we ask:
 How much does your Rx Benefit Plan cost per year?
 Is it part of your medical plan or administered separately?
 Is it self funded or does it have monthly fixed rates?
 May we develop a formal proposal with guaranteed
savings?
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16. Benefit Equivalency
 Same Plan Design
 No Change of
 CoPay
 Covered Medications
 Exclusions
 Benefit Equivalency
Letter
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17. PCA Prescription Savings Cards
Sample Cards
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