Market Growth. Account-based health plans, commonly referred to as consumer driven health plans (CDHPs), are the fastest growing segment of healthcare coverage; and this trend is expected to continue for the foreseeable future. The cost to provide traditional health insurance to an aging population coupled with governmental regulation/health reform is expected to cause traditional health insurance premiums to continue to increase at an alarming rate. Add a struggling economy, and an ideal scenario is created for the explosive growth of CDHPs. Almost half the market has already shifted to HDHPs to lower premiums with a deductible that is just a little under that required to qualify for a HSA. The premiums for CDHPs tend to be considerably less than traditional health insurance; and as traditional health insurance premiums continue to climb, the healthier population, that historically has subsidized the sicker population under traditional insurance programs, will gravitate to a CDHP in order to lower their total cost of health care. This will generate a subsidy loss and traditional health insurance premiums will increase even more. This adverse selection cycle is expected to continue over time with the net effect of a higher CDHP population than traditional insurance; and currently, CDHPs are the fastest growing segment of healthcare coverage. This trend is expected to continue, if not accelerate, for the foreseeable future.
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Consumer Driven Health Plans
Market Needs. Pharmacy is the most frequently used healthcare service and nearly one out of every five health care dollars is spent on prescription drugs. This quantifies the current need in the market for: 1) a solution that pre-empts a pharmacy's ability to "game" the system by circumventing the adjudication process prior to deductibles being met, and 2) product and/or service differentiators that add significant value to provide a competitive advantage.
PBMs and all other CDH stakeholders are always seeking, a value added, competitive differentiator. However, the CDH market is very highly regulated; and this makes it exceedingly difficult to differentiate their various offerings. Customarily, differentiation is based upon fees and/or investment portfolios, or perhaps an ancillary service; and no firm wants their competitive edge to depend on their fees. The Patient Driven Rx℠ solution provides a significant value proposition and significant service differentiation that mutually benefits the PBM, the PBM’s CDHP clients, and all other CDH stakeholders, as well as those consumers each serves by preventing the top five (5) deficiencies inherent under all other CDHP pharmacy programs prior to plan members (consumers) meeting their deductible (see “High Deductible Health Plans” in the menu above for the top five (5) deficiencies).
Pharmacy cash discount cards, high deductible health plans (HDHPs), and consumer driven health plans (CDHPs) prior to deductibles being met, are 100% copayment plans. Approximately 90% of CDH members never meet their deductible; therefore:
For 90% of CDH members, their card functions as a cash discount card, and
For 10% of CDH members, their card functions as a cash discount card (100% copay) that converts automatically to a cost-sharing copay card when their deductible is met.
Market Opportunity. To date, PBMs have failed to provide: 1) CDH stakeholders the means to differentiate their product offerings, and 2) the rationale for CDH stakeholders to work in a meaningful and mutually productive way with a PBM. The MBRx medical banking solution, Patient Driven Rx℠, accomplishes both of the preceding objectives. Additionally, MBRx has developed a unique and comprehensive market strategy that mutually benefits the PBM, and a variety of CDH stakeholders that participate as MBRx Channel Partners. The MBRx market strategy enables its Channel Partners to play a more prominent role in eliminating the deficiencies experienced under all current CDHP pharmacy programs and better achieve the growth and revenue objectives of MBRx Channel Partners.
Obviously, early adopters will secure the most significant competitive advantage.