Frequently Asked Questions (FAQ)

COMMUNITY ASSISTANCE PROGRAM (CAP)

Michael White, Regional Outreach Coordinator 407-796-3271

 

WHO IS CAP, NBBI?

1.   What is Community Assistance Program?

 

Community Assistance Program (CAP) is an Outreach Program established by National Benefit Builders Inc. (NBBI).  NBBI is a for-profit company, A+ rated by the Better Business Bureau, which has been in the wholesale discount medical product business since 1994. Because of the nature of our business, we are able to provide discount prescription cards completely FREE to the public through the CAP outreach.  For additional information, visit www.CAP.YouSaveMore.org

2.   What does the Discount Prescription Drug Card do?

·         Provides discounts on FDA approved medications to anyone who would normally be paying full price for their meds;

·         Provides discounts to anyone with limited or no prescription drug coverage;

·         Provides discounts to anyone who has insurance coverage but may require medications that are not covered by their health plan;

·         The prescription drug savings card can also be especially useful to seniors enrolled in Medicare; it has been estimated that as many as 38% of Medicare recipients lack prescription drug coverage.

3.    Why do people need assistance paying for their medications?

There are many reasons people need assistance, a few may be:

·         They are uninsured;

·         They have no company prescription card;

·         They fall into the Medicare “donut hole”;

·         They have Medicaid but they need medications that Medicaid doesn’t cover;

·         They can’t afford to pay the full retail price for their uncovered medicines.

So many people are ordering their prescriptions at the pharmacy, and then never picking them up because they don’t have the money to pay for them – this is called “prescription abandonment”. In fact in 2010, almost 10% of new prescriptions for brand-name drugs were “abandoned,” by people with commercial insurance. People with prescription drug coverage through Medicare Part D or Medicaid are also walking away from too-pricey prescriptions. And the growing percentage of people who have opted for high-deductible plans have to pay out a lot of money before their insurer starts picking up part of it. This according to the WSJ October 12, 2010.

Patients are walking away without their medicines after hearing their cost. They can’t pay full price. They need a discount program.

4.    Who needs a discount program the most?

People who take prescription medications on an ongoing basis. The 10 most prescribed drugs are used to treat hypertension, high cholesterol and depression. The people most often diagnosed with these illnesses are the overweight and the mentally ill. This would tell us that anyplace where we can find these types of people or those who assist them will be a good candidate for using our discount programs. If you wish, you can use Google and look up weight loss clinics, psychiatric treatment facilities, mental health clinics, gyms, exercise facilities, etc. in your local area and call on them.

Senior Citizens even on Medicare. Medicare has a gap, commonly called the “donut hole” , in which senior citizens have a limit of how much Medicare pays for their prescriptions. Medicare pays up to $2840, then the price of the drugs goes up, sometimes 300%, until the senior has paid out another $4550 for his/her meds. Then insurance kicks in again. Seniors need our discount prescription card to pay for their medications that fall into the “donut hole” gap in coverage.

5.       Can a person with insurance still use the drug card?

Yes even people with private health insurance can use the card, usually for meds that are not covered in their plans. Keep in mind that an insurance card cannot be combined with the discount card; either one or the other can be used.

In 2010, across all types of insurance, 4.4% of prescriptions were abandoned during the second quarter, compared to 2.8% four years ago. Consumers are being asked to ante up a higher percentage of the cost of covered drugs, the WSJ reports, and the growing percentage of people who have opted for high-deductible plans have to pay out a lot of money before their insurer starts picking up part of it. This is where the OUR CAP card can be a tremendous help.

CARD USER QUESTIONS

6.       What type of savings can the card user expect and what is included?

·         Card users can save from 10 to 85% on brand and generic drugs with an average of 55% on generic drugs, and 15% on brand name drugs. All FDA approved prescription medications are eligible for the card discount.

·         Also covered are prescriptions for medicines termed as "lifestyle" drugs used for smoking cessation, obesity, erectile dysfunction, hair loss, and infertility to name a few.

7.       What are the limitations of the cards?

CAP is not insurance and cannot be used in conjunction with insurance plans. Due to this fact – there are NO restrictions

• There are no age restrictions;
• No pre-existing condition clause;
• No penalty for smoking;
• No waiting periods to contend with;
• No registration required;
• Both the employed and the unemployed can save money with the card.

These cards can make a tremendous difference in people’s lives, by enabling them to purchase an entire prescription instead of having to buy only a few pills because they otherwise cannot afford the whole amount. In some cases, this card enables people to buy several medications at once, and can save their life if they otherwise would have had to skip some meds because of costs. The free discount card comes ready to use, there is no activation needed. A person just presents it to the pharmacist, and takes his card back to present each time he needs meds. The patient pays only the discounted price, and can use the card over and over again.

8.       What is RX Med Assist?

Our Community Assistance Program (CAP) discount card which as stated above is provided at no cost to the patient requires no paperwork from the patient and no patient qualification on part.  The Rx Med Assist Program is a service that utilizes various Patient Assistance Programs (PAP) and may provide a greater discount on prescriptions for those who qualify. There is a onetime signup fee of $25.00. Once the approval process is completed, the patient pays only $20 per prescription, monthly.

For more information, go to www.CAP.YouSaveMore.org and click in the rectangle at the lower part of the screen that says “Click here for Rx MedAssist”. That will show you the application and answer many questions about the program.

9.       How does the discount card work with the $10 Walmart and Target prescriptions?

The patient is always guaranteed the lowest possible price. So if the $4 price is less than they would have paid with our card, then they cannot use our card for that med.

10.   How does the discount card work with the new e-scrips (emailed prescriptions)?

Some doctor offices are emailing prescriptions to the pharmacies now. If the patient’s discount card info is on file at the pharmacy, then the patient gets the discount and doesn’t have to wait for the scrip to be filled. It is ready and waiting at the counter. The patient can ask the doctor to fax a copy of the card to the pharmacist, or scan and email it with the prescription. The patient can also show the card at the pharmacy when he/she picks up the prescription. If the patient’s card info is not already on file at the pharmacy, the patient should ask for a paper scrip to take to the pharmacy for the first order, so he/she can show the discount card as well. The doctors are not required to use e- scrips so many do not since it is extra work for them. Easier for them to just hand out a paper scrip.

11.   How can card users find out the price of drugs?

Direct them to www.Rx.YouSaveMore.org website where they can do a Drug and Pharmacy lookup.

12.   Do pharmacists always charge the price listed on the site?

They could vary within a few dollars, but most times the price on the site will be what is charged at the pharmacy.

13.   How do our cards work with Medicaid?

Medicaid mostly works only in the state where the patient lives, unless other arrangements have
been made in advance. Each state has different rules about accepting out-of-state Medicaid, and

not all pharmacies participate in the Medicaid program. In this instance, our card would prove very helpful to get a discount as the card is accepted nationwide!

Also, remember that MANY drugs, especially brand name, are not covered under Medicaid, and our card offers a discount on ALL FDA-approved drugs.

14.   Can the card be used for mail order, online, and phone order prescriptions?

If there is a space to fill in a discount card number on the online ordering form then it can be used. Most likely though, for phone and Internet orders, the member will need to call the pharmacy to make sure that the discount card can be used.

15.   Are the prices listed on the OUR lookup site the discounted or retail prices?

Those are the discounted prices, and they vary from pharmacy to pharmacy. Always comparison shop! We found Simvistatin for $188 at CVS, and the exact same drug is $30 at Randall Manor Pharmacy, and $89 at Walgreens.

OUR CAP FUNDRAISER POTENTIAL

16.   What is Our Earning Potential for Distributing the CAP Cards?

OUR partners receives .75 cents for EACH prescription processed, EACH time Our unique card is used. With just 1000 patients using the card monthly, OUR partners earns $750 monthly.  The potential for a Nonprofit is quite large with all members taking ownership and continual action.

 

What are the most important things I need to know or do to be successful in this business?

·         Order more cards – minimum 10,000 per month.

·         Place cards only where people use meds.

COMPENSATION

17. How do our fundraiser earnings work? When does OUR receive funds?

Fundraisers compensation are paid beginning 90 days* after signing up and when OUR accumulates $25.00 in earnings. Funds are paid via ACH (Automated Clearing House) or direct deposit. This will be paid around the 21st-25th of (month). NBBI does not issue payments for less than $25.00.

 

*There is a three month lag in payment because the Pharmacy Benefit Manager (PBM) has to bill the pharmacy. The pharmacy has to pay the PBM. Then the PBM pays NBBI, then NBBI pays OUR. OUR payment is made about a week after funds are received from the Pharmacy Benefit Manager.

 

18. How quickly will our cards get used?

Often they are on someone’s desk for a while (social service counselor, managers of self-pay department, clinic nurses, etc.) and get handed out slowly but surely to the people who need them. And once people receive the cards, it may take a few months before they actually use them. Perhaps they just picked up a 90 day prescription recently. And if you hand out cards to the general public you will not see as big a return. They must be handed out to the right places to see usage. These places include clinics, hospitals, doctor offices, pain management centers, and other places where people take multiple medications on a recurring basis.

There are times when scripts are not compensable, such as when someone gets a $4 prescription at Walmart or Target. Since the patient is guaranteed the lowest possible price, the $4 is already as low as the med can go, so our card is not usable in that instance. Sometimes meds are ordered and never picked up (prescription abandonment) and so a script would not be compensable there either. The majority of attempts to use our card go through successfully and are compensable claims. Remember that we must distribute thousands of cards before we see a regular return.

19. How can there ever be a negative scrip?

When a compensable prescription is put through by the druggist a +1 is generated. When a compensable prescription is reversed by the druggist a -1 is generated.  You only see the -1 when there is no other activity on the number/rxgroup for the month. Otherwise, it would be netted with other compensable counts.

 

We do not know why a druggist reverses any particular prescription, but here are some possible explanations:

1)         Entered to wrong rxgroup.

2)         Prescription not picked up (Prescription Abandonment)

3)         Order cancelled because drugs could not be delivered to pharmacy.

20. What factors could negatively affect the OUR scrip count?

• Leaving too many cards at “free clinics”, where people already get their meds free.
• Leaving too many cards with dentists, where people only use them once for an antibiotic or pain reliever.
• Leaving too many cards with clinics that have their own in-house pharmacy.
• Leaving cards with Emergency Rooms that have a special arrangement with a pharmacy already to give discounted rates.
• Don’t leave more than 50 cards on the first visit. Leave them at most 50, let them get good results, then follow up and send them a re-order of 50 cards. Why? If they had one negative experience and you left them 500 cards, they may just toss the rest of the cards. Don’t let that happen!
• Remind users and social workers, clinics, that the patient should show their card each time at the pharmacy, and NOT rely on the pharmacy to keep the info in the system?

THE CAP CARD

21.     How can this card be free? Where does the medication discount come from? Who is funding it? How can this program work?

Because of our size and relationships within the pharmaceutical industry, and the volume of business that we bring them, we are able to negotiate lower prices on your behalf. The pharmacies are willing to accept lower prices on the medications in order to bring increased store traffic with add- on purchases. The pharmacies pay the Pharmacy Benefit Manager who brought together the whole network of pharmacies, each time they process a scrip. We get paid by the Pharmacy Benefit Manager who oversees the pharmacy network when the OUR card is used. A patient buys discounted med; the pharmacy pays Healthtrans (PBM) for being in the network; PBM pays NBBI for creating a network of distribution channels like OUR, NBBI pays OUR for distributing the cards to the end user.

22.     Who are the Participating Pharmacies?

Over 80% of the pharmacies in the U.S. and its territories participate. This includes the major chains such as Walgreens, Rite-Aid, Wal-Mart, Target, Kroger, K-Mart, Longs Drugs, Safeway, Tops, Sav-On, Osco, Ongs, Albertsons, Sams, Winn-Dixie, Costco, Brooks, Stop & Shop, Medicine Shoppe, Duane-Reade, Heb, Meijer, Hy-Vee, Giant, CVS, Raley's, Shopko, Bi-Lo, Smiths, Pathmark, Fred Meyer, Aurora, Pamida, Fry's, Kings, ShopRite, Hannaford, and Weiss to name a few.

23.Where should I distribute the drug cards for the greatest result?

Think of places that have clients using the drugs listed in the “Miscellaneous Questions” section of this document. They are used on a regular basis, over and over and often. The smart way to distribute cards is to get them into the hands of the people using those drugs.

Find the states and counties with the highest percent of obesity, sexual disease, seniors, diabetes, etc. You can get this info from: http://www.countyhealthrankings.org

Leave the OUR CAP cards (with permission of course) at health clinics, doctor offices, obesity clinics, etc., places where there are people using medications. You will need to refill them from time to time. Display stands can be ordered in Back Office – just click on the little truck (see below).

24.   In 2011 the pharmaceutical companies will be paying 50% of the value of brand name drugs, when the seniors run into the coverage gap/donut hole. How will this card work then?

We spoke with Nicole Buchannan at Medicare, who is a Supervisor there. She stated that whatever the price is that was paid at the time of picking up the scrip, including discounted amounts that’s what is recorded. So it does affect the coverage gap/donut hole. If they only pay half for the scrip, they still have to wait till they reach whatever the coverage gap total is prior to receiving the $250 rebate amount. They did not have anything in writing on their site or in their literature that reflected this; they just stated it needs to be communicated to anyone who is using Discounted Scrip Cards.

FUND RAISING (FRO) AND NON-PROFITS (NPs)

31.Why don’t the OUR branded cards say “free” on them?

Some fundraising organizations choose to ask for a donation for the cards. The organizations ask for a donation such as $3 per card, or 2 for $5 and get .75 cents per scrip every time the card is used.

EMAIL AND FAX

32.If a Volunteer uses a service to send Faxes or E-mails, is it Spam?

If a distributor (or Volunteer) is sending the fax or e-mail certifies that the people receiving the fax are 100% opt-in recipients, then - it is my opinion that the service can be used. The certification must include the source of the opt-in in the message being sent. The material being sent if different than that which has been already been approved and provided must be reviewed and approved by NBBI prior to sending.

PET CARD QUESTIONS

33. Can our regular card be used for pets or do you need a separate pet card?

Yes! Our people card can be used for pet drugs, and our pet card can be used for people drugs.

MISCELLANEOUS QUESTIONS

We have some making over $40,000 per month and we have some that hand out thousands of cards and have very few scrips. It depends on if they get to the people that need the cards.

We really have only recently started allowing fundraiser type groups and so have not had enough time to give a good evaluation on their effectiveness.  Consistency and Leverage are the keys.  Volunteers should unite in promoting the OUR CAP fundraiser by consistently getting the cards in to medical facilities who have a continual flow of patients who use prescription drugs.

2.         What is the BIN and PCN number sometimes seen on insurance and discount cards?

Rx "BIN" refers to Bank Identification Number, which basically routes electronic pharmacy insurance and discount claims in the right general direction. Rx "PCN" refers to Processor Control Number, which more specifically directs the electronic pharmacy claims. In our case, we just need the BIN to appear and that pulls up all the info the pharmacist needs, including the PCN, to process the claim.

3.         What are some of the most prescribed drugs?

They are for:

1)       Hypertension – Lisinopril 70 million prescriptions yearly, Atenolol 41 million, Metoprolol Succinate 39 million, Metoprolol tartrate 30 million, Lisinopril 20 million, Diovan 16 million

2)       High Cholesterol – Simvastatin 60 million prescriptions yearly, Lipitor 49 million, Lovastatin 15 million, Crestor 15 million

3)       Depression/Anxiety – Alprazolam 44 million, Sertraline 30 million, Lexapro 26 million, Fluoxetine 23 million, Lorezepam 22 million, Citalopram HBR 22 million, Effexor XR 17 million, Trazodone HCI 17 million, Paroxetine 16 million

These drugs alone account for over 575 million prescriptions written yearly.

1.     

2.     

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4. What are some of the drugs that are not normally covered under an insurance prescription drug plan, that our cards will give discounts for?

The following prescription medicines are eligible for the Prescription Drug Discount:

A. Erectile Dysfunction

a.      Caverject injection

b.      Cialis tablets

c.      Edex injection

d.      Levitra tablets

e.      Muse suppository

f.       Viagra tablets

B. Weight loss Agents   

a.      Meridia capsule

b.      Xenical capsule

C. Hair Removal

a.         Vaniqa cream

D. Hair growth Stimulants

b.      Propecia

c.      Hydroquinone containing products (Alustra, Eloquin, Epiquin Micro, Solaquin Tri­Luma)

d.      Monobenzone products (Benoquin)

e.      Tretinoin (Renova 0.02%)

E. Skin/Pigmenting/Depigmenting

F. Infertility Drugs

a.         Injectables such asgonadotropins, and GnRH agonists.

Also, growth hormones, some diabetic supplies, Retin A, non-sedating antihistamines, and Proton Pump Inhibitors such as Nizoral and Lanoxin.

5.         What drugs are excluded from the Medicare Part D formulary?

• Drugs used for anorexia, weight loss, or weight gain
• Drugs used to promote fertility
• Drugs used for cosmetic purposes or hair growth Barbiturates (sleeping pills)
• Benzodiazepines (central nervous system depressants)

6.         Who is our main competition?

There are some pharmacies that have their own prescription discount card programs, but we do not see them as competition since they average only a 20% discount for the people they serve. Our discounts average 55% for generic drugs and 15% for brand names, with no income qualifications or age restrictions. In addition, many of the pharmacies charge a membership fee for their programs whereas our cards are free to the community.

 

7.   I am working with a major health clinic and a department of health. What are some things I can say in an email to convince them to use our cards?

I would use the “How to Use OUR CAP card” flyer as an attachment, but in the body of the email you could say something like:

“Across the country so many clinics, hospitals and health departments make use of our discount prescription cards to help their patients save money on their medications. Sometimes it is the difference between taking meds or going without. Here are some of the reasons these health care professionals offer our cards to people taking medications:

·           The cards provide an average discount of 55% on generic drugs and 15% on brand name.

·           They are accepted at 56,000 pharmacies nationwide, in Puerto Rico and the Virgin Islands.

·           Patients report back with the most wonderful testimonials and are truly grateful that you helped them.

·           Anyone can use the cards, regardless of age, income, or legal status in this country.

·           Every major pharmacy chain accepts the card. Many independent pharmacies are also in the network.

·           The cards are free, can be used over and over and do not expire.

·           There is no personal information gathered or used. The cards all have the same ID number on them which identifies Community Assistance Program, not an individual card user.

·           These cards are offered through an outreach program of an A+ Better Business Bureau company that has been in business since 1994.

·           Discounts are given on smoking cessation products, insulin strips, and many FDA- approved medications that insurance does not cover.”

 

8.   What states have challenges that we should be aware of?

North Dakota and South Dakota have pharmacies that are few and far between. The pharmacy that services a clinic could be 80 miles away. They deliver the meds once a day to the clinics. It is not so easy to print a “list of local pharmacies that accept the cards” in these states.