Press Release Summary = SUNRx Sets the Record Straight
Press Release Body = With all of the lawsuits and bad publicity surrounding many of the industries Pharmacy Benefit Managers (PBM), SUNRx is here to set the record straight about Prescription Benefit Administrators (PBA) and how we are "unique" and set apart from the PBMs.
As the first Pharmacy Benefit Administrator in the United States, with over 60 years of management experience in healthcare, pharmaceutical and prescription plan design, implementations and service, SUNRx advocates true TRANSPARENT Average Wholesale Pricing (AWP). We offer industry revolutionizing Point of Sale technology, Maintenance Medication programs at retail and mail order and incentivized generic offerings that are all designed to maximize safety, efficacy and contain costs. Through our Integrity Based Program, our role as a Client Advocate, and as a contractual Fiduciary for its Clients, SUNRx has experienced growth exceeding 2000% since 2001. We were named the 19th fastest growing company in the United States by Entrepreneur Magazine in June 2005 and the #1 fastest growing company in the Philadelphia region by The Philadelphia Business Journal in October 2005. We will continue to bring unprecedented discounts and savings to the Prescription Benefit market.
Currently there are more than 15 lawsuits against Medco, the industry's largest PBM, that range from fraud to severe lack of performance. Some lawyers argued that Medco pocketed billions of dollars in rebates and other fees from drug manufacturers that should have gone to health plans and consumers while others say that Medco does not fit the legal definition of a fiduciary. Medco was also ordered to pay $7.8 million to the State Teachers Retirement System of Ohio (STRS Ohio) for breaching its fiduciary duty and for fraud. The STRS Ohio board sued Medco alleging that the company overcharged the retirement plan on generic drugs and inappropriately kept manufacturer rebates for itself instead of passing them on to the plan. According to the Attorney General of Ohio, this is the first time that a U.S. jury has recognized that a company managing pharmacy benefits has a legal duty to act in the best interest of retirees and pensioners.
Despite Medco\'s claims that it would act to obtain the lowest possible drug prices for Ohio\'s retired school teachers, Medco allegedly engaged in a series of activities that produced the opposite results. These allegations included withholding drug manufacturer rebates; charging hidden fees and accepting and retaining secret profits; switching patients to a Medco mail-order pharmacy claiming this would lower drug costs, and then charging more for generic drugs than they would cost at retail pharmacies; accepting payments from drug manufacturers to promote more expensive brand name drugs over less expensive generic equivalents; manipulating the committee (through secret payments) that determined what drugs were listed on the formulary; and finally acting as a commissioned sales agent for Merck & Co. These allegations are extremely serious in an industry that depends on full disclosure and full transparency. Officials for Express Scripts, Inc (ESI), the third largest U.S. pharmacy benefit manager, are still battling investigations into the company\'s business practices. According to recent notices, Express Scripts breached a contract and violated other civil laws. Notices allege that the company switched patient medications and did not pass on the savings. In August 2004, New York state Attorney General Elliot Spitzer sued ESI for breach of contract alleging that the PBM enriched itself at the expense of the New York State\'s largest employee health plan by inflating the cost of generic drugs; diverted to itself millions of dollars in manufacturer rebates that belonged to the state health plan; and induced the State to enter into the contract by misrepresenting the discounts the state health plan was receiving for drugs purchased at retail pharmacies. The lawsuit also alleges that in furtherance of its scheme to divert and retain manufacturer rebates that belonged to the state health plan, ESI disguised millions of dollars in rebates as "administrative fees," "management fees," "performance fees," "professional services fees," and other names. AdvancePCS, acquired by Caremark last year, agreed to a $137.5 million fine and a five-year injunction and settlement agreement with the U.S Department of Justice for allegedly receiving kickbacks from pharmaceutical manufacturers in exchange for favorable treatment of their products. This is bad news for Caremark who is also battling a lawsuit filed by four former employees accusing Caremark of restocking leftover prescription drugs and reselling them to customers. The suit also accuses Caremark of engaging in "offensive, illegal and potentially dangerous practices," according to court documents.
There are several questionable methods that PBMs use to generate significant profits without disclosing it to their clients. These methods are the focus of the lawsuits as clients are not aware of the money that could be saved if their PBM was indeed fully transparent.
SUNRx is ready to set the record straight about the differences between most PBMs and the country's first PBA - SUNRx. 1. Price Spreads - This is the practice of charging a different price to the client than what is paid to the dispensing pharmacies. The pharmacy receives less, the client pays more, and the PBM retains the spread between the two. SUNRx operates on a pass-through pricing arrangement; the client pays exactly what the pharmacy is reimbursed. 2. Multiple Mac Listings - Most PBMs have multiple generic MAC (Maximum Allowable Cost) lists, which may average as little as Average Wholesale Price (AWP)-35%. SUNRx maintains one highly aggressive MAC list which, depending on dispensing patterns, may average as high as AWP-69%. This SUNRx MAC list and the "lesser of" pricing formula applies to retail and mail order pharmacy claims. 3. Static Contract Pricing - In the current PBM business model the client must ask if there is any improvement to the pricing schedule (Static Pricing); it is not automatically passed on to the client. SUNRx provides "favored nation" pricing. If we are able to negotiate a better discount or dispensing fee schedule for one client, or if network pricing improves for new clients, the improved pricing schedules are passed on to ALL SUNRx clients. 4. Therapeutic switching - To maximize manufacturer revenue and receive rebates, the PBMs force patients to use medications that are more expensive than the therapeutic equivalents. This is driven by multi-tiered co-payment structures that favor manufacturers and through therapeutic switching which occurs through physicians being influenced by PBMs. SUNRx does not advocate therapeutic switching simply because there is a rebate, fee or allowance associated with the drug; SUNRx allows the patient to select the medication most therapeutically effective, always with cost containment in mind. 5. Re-Labeling Medications - PBM-owned mail order pharmacy facilities often bill according to an NDC number established by a re-labeler. Re-labeled NDC numbers may be as much as 600% more costly than the original AWP. PBMs may offer AWP-23% off of mail order brand drugs, but the AWP pricing can be based on the re-labeled product.
SUNRx does not own a mail order pharmacy utilized by our clients; our edits do not allow payment for re-labeled NDC numbers at a higher rate than the original manufacturer's AWP pricing. In addition, our mail order vendor is contractually obligated to provide to us weekly his purchase order manifest listing the products purchased, package size, quantity and manufacturer. We review the list weekly and provide an approved list of NDCs to be dispensed. SUNRx is moving toward an acquisition-plus basis. 6. Market Share Analysis - Drug manufacturers pay PBMs when their drugs are listed as "Preferred Drugs". These payments may take the form of rebates, fees, or market share allowances. Depending on the client contract the client usually receives only a portion of the rebate dollars. This format will usually increase the client cost, as the "Preferred Drugs" can be more expensive. SUNRx returns 100% of all manufacturer funds (rebates, fees and market share allowances) to the client. 7. Inflated AWPs - Many PBM contracts include language to the effect that the discounts received by the client will be based on an AWP as established by the PBM. This language allows a PBM to arbitrarily modify the base AWP, regardless of established industry benchmark sources, not withstanding the significant abuse by the mail order facilities with re-labeling. This results in inflated AWP prices. SUNRx utilizes Medi-Span and First Data Bank as our source of AWP. This information is updated on a weekly basis.
How to protect yourself and start the saving: - The first step in starting your savings is to request your Prescription Benefit claims data. It's easy and requires little effort on the Client's part. - On a claim by claim basis, SUNRx will process the data through our proprietary audit system and reveal what you would have paid under our program. Through our audit, we will also identify any areas of concern and report them to you. - We'll work with you to transition your old plan to the SUNRx Integrity-Based Model and the savings will begin.
SUNRx is known for unprecedented savings and for being fully transparent and acting in the best interest of our clients..always! Feel free to contact us at (800) 786-1791 or visit our website at www.sunrx.com to see how we can help you significantly improve the performance of your prescription plan. Our clients' best interest is our core focus.
2022
