Independent Pharmacies Start a Medicare Advantage Plan: Idea File

Independent Pharmacies Start a Medicare Advantage Plan: Idea File

Medicare
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Flaviu Simihaian (Photo: Troy Medicare)
Flaviu Simihaian (Photo: Troy Medicare)

Organizers of Troy Medicare have created a Medicare Advantage based on this idea: Maybe local pharmacists are in a great position to make health care work better.

The organizers of the Charlotte, North Carolina-based insurer say they are putting independent pharmacies in the driver’s seat.

The company is on track to sell community-pharmacy-powered Medicare Advantage plans, and Medicare Advantage plans with prescription drug benefits, for the 2020 contract year.

The Organizers

Flaviu Simihaian, Josh Young, Amina Abubakar and Joe Moose teamed up to start Troy Medicare in 2018. Young, Abubakar and Moose all have doctor of pharmacy degrees.

The four founders recruited about 70 pharmacy owners, physicians and other health care professionals to invest in the new company.

Community Pharmacies

The new company is basing its pharmacy benefits package on use of pharmacy networks organized by community pharmacies, such as the North Carolina-based Community Pharmacy Enhanced Services Network.

“We found that community pharmacies were able to reduce readmissions for complex care patients by 45% and reduce emergency room visits by 15%,” the company says on its website.

Patients who get their prescriptions filled at community pharmacies were 25% more likely to engage their physician and 20% more adherent to their medications, the company says.

Simihaian, the new insurer’s chief executive officer, said in a written answer to questions that surveys show that people ages 65 and older trust their pharmacists more than they trust any other health care providers, including their doctors.

Older U.S. residents see their pharmacists about 12 times more often than they see their physicians, Simihaian said.

Because pharmacists see patients so often, they are in a great position to change patients’ behavior and hold down health care costs, Simihaian said.

Community pharmacies will be the preferred pharmacy services providers in the Troy Medicare pharmacy network. The big chain pharmacies will be non-preferred providers.

NADAC Pricing

Troy Medicare hopes to help patients overcome concerns about lack of clear, complete drug price information by using a new pricing approach, Simihaian said.

Troy Medicare plans to use the National Average Drug Acquisition Cost (NADAC) service, a public drug price information service, to set its prescription reimbursement rates. Using the NADAC service will help pharmacies and patients know exactly what each prescription will cost, Simihaian said.

Simihaian said some agents will be able to earn commissions by selling Troy Medicare coverage. He did not provide details about how the company’s managers might work with agents and brokers.

“We rely primarily on word-of-mouth and distribution through the local pharmacies and providers we partner with.

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