How We Do It

Once a plan is up and running, then we work on the mission — controlling costs and providing excellent client and member services. The philosophy that the client and their members should always talk to the same person is the fundamental reason why we can control costs better than the rest. It is also what enables us to provide a level of service that exceeds all others.

Cost Containment
When asked how we are able to contain costs better than others, one of the key elements identified is "manual intervention." In short, we look at more claims using "human logic" in the adjudication system. Systematic adjudication of claims is only as good as the "system" allows it to be. With the single point of contact between the client services team member and the members, and the synergy that develops, we are able to "catch" things that a "system" cannot, helping reduce utilization and cost to the plan. In essence, we plug the leaks through critical thinking and problem solving skills. To support this, we keep an extensive notes database that tracks the decisions made on every member and process.

• Coordination of Benefits where savings range from 3 to 10 percent.
• Tighter Cobra Management with savings ranging from 2 to 5 percent.
• Tighter Eligibility Management with savings ranging from 2 to 5 percent.
• Continuous monitoring of our network PBMs, saving between 1 to 3 percent.

If Coordination of Benefits makes sure that the correct medical plan is paying for the services, why shouldn’t that be the case in the pharmacy benefit? At DrugCard, it is. We will implement a COB program so that your company pays for the drugs for your employees and families where the spouse has no other coverage. If the spouse does have other coverage, then we will coordinate the benefit.

Pharmacy plan use and cost is immediate. Once the member takes their prescription into the pharmacy, has it filled and pays their copay, the plan will pay for the prescription. Tightly managing eligibility will prevent terminated employees from using the benefit, saving the plan money that may "leak" out if terminated employees remain in the system. DrugCard guarantees a four hour window when notified of any employee status change — even adding them to the plan.

Client and Member Services
As mentioned earlier, a single point of contact for you and your company’s members helps save the plan money. But there is another benefit — personalized service. Ask any of our clients and they will tell you the name of the representative and how much they’ve done for them. Our goal is to make sure that any problem is resolved immediately; and if that can’t be done then we keep the member informed of our progress.