A prescription drug strategy that leverages Cost Plus Drugs as the primary fulfillment channel, supplemented by a discount card program for uncovered medications.
đź’Š Prescription Strategy Overview
🧩 1. Default Flow (Cost Plus)
- Preferred channel: All covered members use Cost Plus for prescriptions.
- Integration: Your insurance plan (or HSA-compatible wrapper) has a direct link to Cost Plus’s pricing and ordering system.
- Benefit: Cost Plus pricing is transparent, fixed markup, and eliminates PBM middlemen.
đź’Š 2. Backup Channel (Discount Card)
When a medication isn’t available through Cost Plus:
Option A: Partner with an existing network
- Work with a transparent PBM alternative like SingleCare, GoodRx, or ScriptCo as a fallback.
- You can white-label these as a “ReachRx” or “LucernaRx” card.
- When a member goes to a pharmacy, they present this card.
- You negotiate to collect de-identified usage data to track costs and identify drugs to push onto the Cost Plus formulary later.
Option B: Build your own discount network
- Use NABP-accredited mail-order or retail partners who agree to a cash-price schedule (like the Medicare or NADAC benchmark rate + small fee).
- You aggregate these into your own internal “discount card” system.
- Members can see both Cost Plus and your fallback prices in one app or portal.
⚙️ 3. Implementation Options
| Approach | Description | Complexity | Notes |
|---|---|---|---|
| Affiliate Discount Card | Partner with GoodRx, SingleCare, etc. and brand it | Low | Quick, compliant, immediate coverage gap fix |
| Custom Cash Price Network | Negotiate directly with independent pharmacies | Medium | Higher control, better margins, more work |
| PBM-Lite Arrangement | Use a transparent PBM like CapitalRx or Navitus for limited formulary management | Medium–High | Keeps compliance and adjudication simple |
| Hybrid Portal | Members see both Cost Plus and fallback prices, choose best | Medium | Gives consumer control, reinforces transparency |
đź’ˇ Strategic Advantage
By combining Cost Plus + a transparent fallback:
- You sidestep PBM rebate games entirely.
- You maintain transparency — members always see what each option costs.
- You can learn from real-world purchasing data which drugs matter most, and potentially negotiate Cost Plus to add them.