National Health innovations

Introduction to Select Rx Global Specialty & Brand Name Programs

Our Unique Approach

Fiduciary mindset, placing the needs of clients first

NHI is committed to providing a roadmap for clients to navigate their pharmacy-benefit risks and costs effectively.

We make recommendations and decisions with utmost care, honesty, and transparency.

Technology & Innovation

Our clinical rigor and lowest-net-cost sourcing methodologies ensure that enrollees have access to cost-effective and clinically appropriate medication therapies.

Proven Strategies & Solutions

Customizable, low-net-cost formulary which provides:

  • Consistent cost reductions of >30% for specialty medications; higher savings for brand name drugs
  • Flat per-Rx administrative fee

No changes to benefit structure

  • We work adjacent to our clients’ PBMs

No conflicts of interests, exclusive focus on:

  • Quality of care
  • Plan sponsor and member cost savings
  • Member experience/satisfaction

Minimal interruption to enrollees

  • Step-by-step guidance
  • Mail-order service for discounted specialty/brand name medications

Select Rx

Global Specialty & Brand Name discount prescription programs

specialty rx program

Global Specialty Mail Order

SPECIALTY RX OVERVIEW

What are specialty drugs?

Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis, hemophilia, multiple sclerosis, etc.

How does it work?

NHI works with our PBM to source and provide access to lowest-net-cost specialty drugs for your enrollees, with average savings of 30% or more.

Our specialty drug origins

NHI sources specialty drugs from international tier 1 pharmacies in Canada, Australia, New Zealand, and the United Kingdom.

THE PROBLEM

Specialty drugs comprise only 2.2% of all prescriptions, yet account for over 50% of national drug spending and in 2023 will likely reach $500 billion. These high-cost treatments, although pivotal for patient care, present a formidable financial challenge for employers and enrollees alike.

  • The average annual cost of a specialty medication in 2019 was about $79,000 per year, according to AARP.
  • Specialty medications were estimated to represent nearly 50% of pharmacy benefit spend in 2020, according to the Express Scripts Drug Trend Report.
  • Specialty tier drugs can require coinsurance of up to 33%, leading to high out-of-pocket costs for enrollees, according to a study by the Kaiser Family Foundation.

the challenge in specialty drugs

Employers/Plan Sponsors

Struggle to balance providing necessary medications for enrollees with managing escalating costs and ensuring the sustainability of the health plan.

Employers often feel powerless to influence specialty therapy prescribing despite the high prices charged by manufacturers.

Employees/Enrollees

Face barriers in accessing vital medications due to:

  • High out-of-pocket costs
  • Complex administration
  • Potential availability issues

real world Example: Global Specialty Mail Order

Tremfya 100mg/mL 1 syringe $13,351.29 $8,887.31 33.4%
Tremfya 100mg/mL 2 syringes $26,092.20 $17,016.01 34.8%
Stelara 90mg 3 syringes $81,161.48 $50,705.02 37.5%
Stelara 45mg 1 syringe $27,536.89 $16,433.32 40.3%
Skyrizi 150mg/mL 1 syringe $18,747.88 $12,115.49 35.2%

*medication pricing subject to change based on fluctuation of drug costs

HOW WE DO IT - CASE STUDY

NHI ASSISTS YOUR ENROLLEES TO PURCHASE SPECIALTY DRUGS AT 30-50% LOWER COST

We share the cost savings with the employer

A self-insured employer with 500 enrollees

15 enrollees require specialty Rx at average cost to employer of $80,106/year per employee

Total annual cost to employer $1,201,590/year

With Select Rx, annual cost to employer is $781,034/year (average gross savings of 35%)

Employer net savings are $210,278/year

For More Detailed Info on the Case Study, Click Here

select rx

Brand name rx program

Global Brand Name Mail Order

Discount brand name rx program

We offer our clients considerable savings on brand-name medications.

How it works

  • Members are eligible to purchase brand-name medications to treat such conditions as anxiety/depression, cardiovascular disease, and chronic gastrointestinal disorders.
  • As with the specialty medications, we source brand-name medications from tier 1 pharmacies in Canada, Australia, New Zealand, and the United Kingdom.

real world EXample savings:

Abilify 10mg 84 tablets $2,951.89 $174.37 94%
Arava 20mg 90 tablets $3,842.93 $104.61 97%
Rybelsus 7mg 30 tablets $914.10 $326.95 64%
Invokana 100mg 90 tablets $1,476.50 $297.23 80%
Januvia 100mg 84 tablets $1,259.13 $170.25 86%
Xarelto 20mg 84 tablets $1250.22 $218.44 83%
Otezla 30mg 100 tablets $5322.57 $236.70 96%

*medication pricing subject to change based on fluctuation of drug costs

Getting Started with select rx

Global Specialty & Brand Name Programs

A two-step process

Step 1: INFORMATION EXCHANGE

1

CLIENT

Provides current specialty/brand name drug information

2
NHI

NHI

Reviews in-force specialty/brand name drug claims costs

3
NHI

NHI

Negotiates with service providers

4
NHI

NHI

Provides an estimated cost savings proposal to the client

Step 2: Decision & orders

5

CLIENT

decides what medications & from which countries to order

6

ENROLLEE

Submits signed prescriptions to NHI

7
NHI

NHI

Assists enrollees to order specialty/brand name medications

  • Manages all questions from the pharmacy
  • Provides order tracking number via email
  • Notifies when refills are due

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