About Gary Becker, CEO, ScriptSourcing
Since 1985, Gary Becker has been an innovative presence in the employee benefit industry. In 2009, Gary developed the first benefit captive in the Mid-Atlantic marketplace, banding together like-minded mid-sized employers who were interested in transparency, control, and risk management. Gary is a charter member of the Agency Growth Mastermind Partnership and credits much of his success to this proactive group of “disrupters” who are on a mission to re-engineer employee benefit plans and produce quantifiable, meaningful results. In 2017, Gary developed the Achieve Health Alliance, a first of its kind benefit consortium in which both employers and consultants have aligned interests and share stop-loss underwriting profit.
About ScriptSourcing
ScriptSourcing, LLC helps self-funded employers and their members by providing $0 rx copay solutions for many maintenance name brand and specialty medications. ScriptSourcing’s creative approach produces a win/win for employers and plan members… generating savings in excess of 70%.
Medical Travel Today (MTT): Tell me about ScriptSourcing and the company’s value proposition.
Gary Becker (GB): We make available a zero rx copay for members of self-funded health plans for many name brand drugs, as well as specialty drugs. On average, we help employer health plans save 50 to 90 cents on the dollar.
MTT: Those are incredible savings.
GB: It sounds too good to be true, but it is. We are sourcing meds through our international pharmacy management program for huge savings, and we’re able to source some of the specialty meds at no cost.
The way it works, we identify individuals who are taking meds that are eligible for our programs. It’s our job to engage, educate, incentivize, and ultimately, help them enroll in one of our programs.
Our solutions are voluntary and we encourage members to do what’s in their and their family’s best interest. We are helping folks adhere to their medications … and given that 20% of hospitalizations are due to medication non-adherence, we’re helping health plans better manage risk.
Our business model is that we don’t charge fees for administration or set-up. We work on a performance based compensation arrangement and our clients love it! Bottom line: If we don’t save the employer any money, we don’t get paid.
When we’re successful helping members, the employer keeps 75% of the savings. We create a win/win for the member and the health plan. In addition, the members are incented to use our services with, for example, Visa gift cards.
Here at ScriptSourcing, all of our interests are aligned when members choose to use our services. We are all sharing in the savings we deliver to our clients.
MTT: Talk to us about the medications and how they are sourced.
GB: We have an international pharmacy management program, and we’re working with four Tier-1 countries. These are countries that have been deemed by Congress to have the same or higher standards and regulations as the FDA. We work with four English-speaking countries — Canada, the United Kingdom, Australia and New Zealand.
All of these countries have socialized medicine. They negotiate directly with the pharmaceutical companies, and are paying 5 to 50 cents on the dollar for the exact same medications, which are factory-packaged and sealed by the same manufacturers.
MTT: So you are buying the medications?
GB: No. We are simply providing access to an international pharmacy management program, which in turn is able to identify the best prices from the pharmacies in these Tier-1 countries. Those meds are being shipped from brick-and-mortar pharmacies that have real pharmacists that are located in those countries and serving the citizens of those countries. They’ve been doing this for 2 decades with no problems. No one has ever received the wrong medication, and there’s never been a single issue.
MTT: How are you identifying these pharmacies?
GB: We have a network of pharmacies that have been inspected and have great operations, unlike global pharmacies that operate as internet pharmacies where there’s no pharmacist and they are selling bad drugs.
We know the right pharmacies that have all the right safety protocols. This makes it possible for individuals to adhere to their medicine. The program is completely voluntary, but many people do respond to the incentives.
Employees on our team approach members and let them know about all of the benefits, such as no copay and the ability to get a 90-day supply shipped right to their door.
If you have a preference in using your health plan’s pharmacy benefit manager (PBM), and you like the pharmacist that you currently go to, and don’t mind paying a high copay, you are welcome to do that. But 70 percent of households in the United States have a $1000 or less in their savings accounts, and half have no savings at all.
So, when we can go to an employer and make this option available, it is very well received because we are helping employees afford their medications and we’re saving employers a significant amount of money in the age of rising healthcare costs. Members also understand that healthcare is expensive, and that we are all in this together in terms of saving money.
MTT: You mentioned that you got some of the meds for zero cost. How does that work?
GB: We have a number of ways for sourcing medications at a lower cost. I mentioned the international pharmacy management program, which has costs. We also have international medical/prescription tourism program which we can send people around the world for treatment. They can get their medications at a much lower cost than here in the U.S. This is a new program that we are very excited about.
We also have a program in which we work with a combination of manufacturers, foundations, both private and public. Without giving away too much, all I can say is that these manufacturers give away billions of dollars of meds annually, and we are able to help some of our members benefit from the generosity of these manufacturers.
It’s been a great success. We are able to get meds that are fairly common, like Humira and Embrel for rheumatoid arthritis that can cost $50,000 to $100,000 for free.
MTT: Now tell me how this international prescription tourism works.
GB: Well, for example, there’s medications, such as Sovaldi and Harvoni that cure Hepatitis C that costs $1150 per pill. A 12-week treatment costs $94,500.
There are opportunities to go to places like the Cayman Islands where, for under $20,000, we offer a package that enables a member and companion to travel to the Cayman Islands for a couple of days, all expenses paid, to get treatment at Health City – one of the most extraordinary hospitals in the western hemisphere – this facility is the “Henry Ford” of medicine.
The efficiency, outcomes, low infection rates, patient satisfaction, and care quality at Health City are phenomenal.
Members learn how to take the medication, and there is coordination of a hand-off with the treating physician in the U.S. We are saving the employer in excess of $70,000 for Hep C treatment.
The same savings can be achieved for many other medications as well.
MTT: And so who first prescribes the medication?
GB: An American doctor prescribes it. A Health City doctor treats the member and prescribes the less expensive version of the same medication.
MTT: So you could replicate this in Cancun, for example?
GB: We’re in the process of replicating the international medical tourism option in Cancun and possibly some other locations in Mexico. Numerous high cost name brand medications will be available in Mexico and we will be saving employers millions of dollars. In the meantime, Cancun has become an excellent international medical tourism opportunity. There are programs in which local US doctors travel to Cancun to operate on their patients for a 50% saving. The whole “destination surgery package” costs the patient nothing, the health plan saves a lot of money, and the doctor gets paid 2 to 3 times more.
MTT: How are benefit consultants advising clients to control healthcare costs?
GB: Great question. I work with and am a part of a network of benefit consultants called the Agency Growth Mastermind Partnership. We are truly re-engineering the healthcare delivery system. We are not ok with the status quo, nor are our clients. We consider ourselves “disrupters”. We’re not transactional brokers, we are consultative, delivering a tremendous amount of value that can be quantified and measured.
We empower members of health plans to be very good consumers of healthcare. Our clients have learned that if they are good consumers of healthcare, care can be free or near free. Employers can’t believe it, but they listen to us and recognize the value we bring because they are facing huge deductibles.
There’s a transparency issue. No one knows what medical care costs until you get your monthly bill of benefits for service. This has to change.
We have vendors that provide medical advocacy which identify the very best doctors and the most fairly priced facilities. For example, in my marketplace an MRI could cost $600 to $6,000 depending on where you get treated.
We have vendors that direct contract with diagnostic centers for MRI’s, CAT scans, and X-rays. If members use a particular diagnostic facility, for example, diagnostic care is free.
When a member needs surgery we make available both domestic and international medical tourism programs, which offer opportunities for exceptional care that is far less expensive, and the surgery including travel and accommodations is free.
We are also doing a great job identifying people folks who are at risk or have emerging risk. We work with incredible data analytic vendors that gather medical and prescription data from TPAs and PBMs. They are able to look for gaps in care, such as not taking meds or failing to refill scripts. We play a role in getting the health management companies to do a better job.
MTT: So, from the PBM aspect, did you want to give us just a brief intro to that?
GB: The PBM business is a very dirty business. There is considerable conflict of interest and no true transparency for the employers, who are taking a leap of faith to self-fund their benefits because they want transparency.
PBMs provide a service called Prior Authorization to help determine whether a medication is appropriate. Many PBMs own their own specialty pharmacies which dispense high cost medications for complex chronic conditions. When a pbm owns their own specialty pharmacy, a conflict of interest exists and we often see a low denial rate. The largest PBMs are public companies and have a responsibility to return profits to their shareholders, so they’re not always doing what’s in their client’s best interest. It’s like the fox guarding the hen house. They are standing on the same side of the table as their shareholders, not with employers.
What’s more, doctors have no idea the cost of the meds they are prescribing.
We only work with fiduciary PBM’s — those that are held to a higher standard, offer complete transparency and engage in higher clinical practices.
MTT: You need an honest gatekeeper whose interests are aligned with the employer and not their shareholders.
GB: Exactly, and that’s why we’ve created a specialty med review program, which employers can relate to. If a medicine is prescribed as a specialty med, we ensure that it is the right drug for the right person at the right time — and the right cost. When it comes to a specialty pharmacy, we offer a wide range of choices akin to an Expedia-like experience.
We have a network of pharmacies that compete and bid for the business, and we get the best possible price, combined with the option of using our MAP program or international pharmacy program so that the cost could be much less or even free.
We don’t charge an administrative or set up fee. Our clients pay for performance. As I mentioned before, if we don’t deliver value, we don’t get paid. This means we put a lot more hustle into the work we do on behalf of the employer and employee.