Innovative Prescription Solutions for a Healthier Tomorrow
Non-Insured Options Available
PRAM also has a host of non-insured options available to be sold on a group or individual basis. These robust programs provide peace of mind when the higher cost of insurance isn’t palatable.
TRADITIONAL INSURED PHARMACY
Fully-Insured Shelf Rated Pharmacy Plan Options
PRAM Insurance Services, Inc. proudly offers its traditional shelf rated plans, providing a versatile and accessible solution for groups ranging from 5 to 1,000,000 lives. These plans are designed to deliver comprehensive pharmacy benefits without the need for custom underwriting, making them an ideal choice for organizations seeking efficient and hassle-free implementation. Our Shelf Rated Plans are meticulously developed to ensure robust coverage, affordable pricing, and seamless integration into the health benefits marketplace.
With PRAM’s Shelf Rated Plans, clients benefit from guaranteed acceptance, no waiting periods, and inclusive coverage for all pre-existing conditions. These plans come with comprehensive formularies and are supported by a vast pharmacy network of over 70,000 pharmacies across the United States, including all major chains and a substantial number of independent pharmacies. Additionally, our Shelf Rated Plans can be private-labeled, allowing organizations to offer branded solutions that enhance their value proposition to their members. PRAM’s commitment to excellence ensures that our shelf rated plans deliver superior performance and peace of mind for both the distribution partners and their clients.
TRADITIONAL INSURED PHARMACY
Fully-Insured Custom Underwritten Plans
PRAM offers Custom Underwritten Plans designed to meet the specific needs of large groups with 1,000 or more lives. Our expertise in pharmacy benefits and risk arrangements allows us to create tailored solutions that align perfectly with the unique requirements of each organization. By working closely with our Distribution Partners, we ensure that our custom plans provide comprehensive coverage, competitive pricing, and robust formularies, all while maintaining the highest standards of care and service for the end user.
Our Custom Underwritten Plans are meticulously crafted through a thorough underwriting process that takes into account the distinct characteristics and needs of the group. This personalized approach enables us to offer plans that not only meet but exceed the expectations of our clients. With guaranteed acceptance, no waiting periods, and coverage for all pre-existing conditions, our custom plans deliver unparalleled value and peace of mind. Additionally, these plans can be private-labeled, allowing organizations to offer branded solutions that enhance their own value proposition to their members.
TRADITIONAL INSURED PHARMACY
Specialty Drug Management
PRAM Insurance Services, Inc. is at the forefront of managing Specialty Drug programs, offering fully insured products that cater to the unique needs of high-cost medications. Specialty drugs, typically retailing for over $600 per prescription, require specialized management to ensure both affordability and access for patients. PRAM’s expertise in underwriting these programs allows us to deliver tailored solutions that meet the complex requirements of these high-value therapies. Our fully insured Specialty Drug plans provide comprehensive coverage, ensuring that patients receive the medications they need without financial burden.
In addition to our fully insured products, PRAM offers discount patient advocacy services designed to further support individuals requiring specialty medications. These services provide significant cost savings and personalized assistance, helping patients navigate the complexities of their medication regimens and access the best possible care. Our patient advocacy services are an integral part of our commitment to delivering holistic, patient-centric solutions. PRAM strives to ensure that individuals receive not only the medications they need but also the guidance and resources to manage their health effectively.
SELF or level FUNDED PHARMACY
Self-Funded
- Small Group (5-1,000) – This self-funded option offers PRAM’s outstanding pricing traditionally provided to our fully insured clients, to our self-funded clients now as well. PRAM will provide all of the same innovative cost saving strategies and plan offerings. We will either match the client’s requested plan design, or provide a unique option based on the client’s pharmacy benefit goals.
- Large Group (1,000+) – This self-funded option utilizes the client’s detailed claims experience to provide a full suite of savings opportunities. We will incorporate the PBM likely to provide the most significant financial impact to the client, in addition to offering a host of program options with estimated savings and increased health efficiencies to the overall population.
Level-Funded
(For groups 5+) Offered in states where fully insured coverage is unavailable. These programs mirror the PRAM fully insured pharmacy options. The difference is that the clients are self-funded with optional stop loss coverage to cap the client’s downside.
PHARMACY benefits
Pharmacy Benefits Consulting
Leveraging detailed claims data, PRAM offers invaluable analytics to enhance your pharmacy benefits programs. Our services include comprehensive claims auditing, identifying potential savings through various program opportunities, and providing strategic recommendations for plan design and formulary adjustments based on current experience.
Whether you’re looking to build a program from the ground up or optimize an existing one, we tailor our solutions to align with your overall benefit goals and budgetary needs.
- PBM contract monitoring and/or auditing
- PBM selection based on client goals, pricing, ease of administration, willingness to customize, etc.
- All aspects of program design – goal, budget, & risk based
- Management of program enhancing products
- Innovation/Creation of new custom programs to fit distribution partner/client needs
AGGREGATE stop loss
Pharmacy Stop-Loss
Our Pharmacy Stop Loss program offers comprehensive coverage that includes both medical and pharmacy components while leveraging PRAM’s proven pharmacy cost containment model. We start by carving out the pharmacy benefits and implementing our targeted clinical programs to ensure both patient efficacy and cost reduction. By effectively managing the expenses associated with outpatient retail pharmacy and inpatient medical pharmacy, we establish a lower baseline for pharmacy costs. This approach allows us to integrate stop loss coverage more efficiently, ultimately saving our clients money on their overall pharmacy and medical stop loss expenses. The result is comprehensive coverage that meets clients’ needs at a significantly reduced total program cost.
Get in Touch with Us Today
Kelley Kaurich
EVP of Sales and Marketing
Capstone Management Group
(317) 840-1753
