Under pharmacy cash discount card programs it is not uncommon for PBMs to experience a claim adjudication reversal rate of up to 50%. When adjudication circumvention occurs, neither the patient nor the PBM have any way of knowing it has occurred at the point-of-sale.
This deficiency leaves the patient vulnerable to:
Paying more than their PBM's network contract rate, and
An inability to receive concurrent Drug Utilization Review on all prescriptions - thereby making them susceptible to drug therapy related problems which otherwise could have been detected and avoided.
This deficiency leaves the PBM vulnerable to:
A high attrition rate. Pharmacies can easily switch patients to their loyalty discount cards by representing to the patient that their card provides them a better (less expensive) price.
A significant loss of revenue. PBMs do not receive revenue when pharmacies circumvent the adjudication process.
However, PBMs that utilize the MBRx medical banking solution, Patient Driven Rx℠, are inoculated against efforts to switch the patient to a different card, once patients understand:
There is a current industry-wide deficiency for the pharmacist can disregard the price they are supposed to charge the patient and instead establish a higher price without the patient’s knowledge, and
Patient Driven Rx℠ is the only safeguard available to protect them from the vulnerability of being overcharged.
Once patients understand these two points, any attempt by a pharmacy to switch them to an alternative loyalty card will be met with resistance and suspicion as to the pharmacy’s ulterior motives. No one feels comfortable knowing they are vulnerable to being taken advantage of without their knowledge. This issue strongly appeals to patients! The Patient Driven Rx℠ medical banking solution generates a significant value proposition that increases the patient’s perception of value and satisfaction.
In addition to enabling PBMs to significantly diminishing their attrition rate, PBMs that utilize Patient Driven Rx℠ will realize a significant increase in the revenue derived from their discount card line of business due to pharmacists’ inability to circumvent the claim adjudication process. The Patient Driven Rx℠ medical banking solution generates a significant value proposition by differentiating the PBM’s products and service, as well as increasing its revenue.
Obviously, early adopters will secure the most significant competitive advantage.
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