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Snezana Mahon, Pharm.D., Transcarent’s chief operating officer, discusses the company’s efforts to provide a seamless and interconnected pharmacy ecosystem.
Transcarent has teamed up with Prescryptive Health to provide self-insured employers and their employees access to Prescryptive’s network of more than 60,000 retail, home delivery and specialty pharmacies. Transcarent, launched in March 2021 to support self-insured companies, offers medication review and management, virtual physical therapy, behavioral health care, oncology care, and site-of-care surgery solutions. Currently, Transcarent has more than 100 clients serving more than 1.5 million members.
Transcarent aims to use the Prescryptive digital platform to be able to support and power core elements in pharmacy benefits, including transparency to consumers and employers and a seamless and interconnected ecosystem for pharmacy benefits, Snezana Mahon, Pharm.D., Transcarent’s chief operating officer, said in an interview with Formulary Watch.
One pain point for consumers is affordability and lack of transparency about price. More than 50% of consumers, Mahon said, don’t know if a medication is covered by their insurance and what the cost is. “I’ve seen firsthand as a pharmacist working in the retail setting, patients walk away from the pharmacy counter, because they didn’t realize the medication is not covered, or they just simply couldn’t afford it,” she said.
Through the partnership with Prescryptive, Transcarent Pharmacy Care Members will be able to shop for their own prescriptions. Consumers can view real-time price data, select a pharmacy to fill their medication or a home delivery option, know the price they will pay, and make more informed decisions. “We’re giving consumers a broad array of information about all pharmacies in the country, both traditional local pharmacies, retail pharmacies, chain pharmacies, home delivery pharmacies, as well as some of the new age digital pharmacies."
“When you think about claims adjudication, network management, the ability to give the member choice of pharmacy, real-time text messages in the moment of decision making, we’re leveraging the Prescryptive platform to power this broader Transcarent experience that we’re delivering across the board,” she said.
Mahon said another pain point is that the pharmacy benefit is disconnected from the medical and the behavioral healthcare benefit. Transcarent’s connectivity within this ecosystem allows both members and their physicians see whether a medication is covered and what the price will be at the pharmacy.
For self-insured employers, Transcarent provides administrative services in pharmacy care, behavioral health, oncology, and surgery. The company can help take the burden off human resources teams, Mahon said. “The average employer has three medical carriers, one pharmacy benefits manager and five to 16 point solutions. The ecosystem is very complex, very cumbersome and very expensive to manage administratively. The first benefit to an employer is that get access to all of these services from one place and one contract.”
The new partnership also gives employers and health systems control over their formulary, benefit designs, and data. Mahon said their clients have full audit rights for all claims, from NDC level to rates at the pharmacy to rates with the manufacturer. “A big challenge today in the industry is an employer getting access to that information. They’re being asked to pay fees and other metrics to receive that data theirs. We will rightfully give them whatever data they need as an employer to manage their members’ benefit,” she said.