Overview
That OptimumRX Card pays broker commissions and to please call to review broker programs. That OptimumRX Card also administrates Self Insured (funded) prescription programs. Optimum HealthCard has developed a product designed to offer a low cost option to employers and associations to provide prescription benefits. This product makes available hundreds of generic and low cost brand name drugs at $10, $20 and $40 maximums. Through the use of a Preferred Drug List the member is able to have a choice in their prescription drug benefit. The member is instructed to become involved in their prescription drug choice. The member should take the Optimum HealthCard Preferred Drug List with them to their physician and have the physician prescribe medication that is therapeutically equivalent. Optimum HealthCard has negotiated substantial discounts on thousands of Non-Preferred drugs which are available at more than 50,000 pharmacies nationwide.

Implementation
Optimum HealthCard will provide your members with an ID card and a Preferred Drug List booklet which describes in detail how the program works. This plan is available on an individual and a family basis. This plan can be marketed as a stand-alone product or bundled with a variety of discount health products. Optimum HealthCard can typically enroll your members within 5-10 days. Eligibility should be transmitted electronically but we do accept hard copy enrollment in the Optimum HealthCard Plan. The Client has the option of having the fulfillment materials sent directly to the member’s home address or in bulk to the employer or association headquarters. The fulfillment kit includes a plastic ID card and the Preferred Drug List.

Plan Design
Prescription benefits are ranked as the fourth most important work related benefit, topped only by retirement plans, paid time off and medical insurance. In today’s healthcare world, no employer can afford to ignore the importance and the perceived value of a prescription drug program.
Controlling these pharmacy costs is one of the most challenging aspects of managing the healthcare budget. The Optimum HealthCard Plan allows sponsors to control costs, increase plan design options, eliminate claims administration and remove a sponsor’s exposure to pharmacy risk.
In addition, these plans:
Educate employees on drug costs and promote less expense generic equivalents
Utilize “flat dollar” co-payments to increase consumer awareness of drug costs
These plans can offer employers the ability to “carve out” prescription drugs from the health plan in order to manage those costs separately while targeting employee utilization more specifically.
Optimum HealthCard creates and administers many different plan designs. The Optimum HealthCard Plan is designed to maximize the benefits available to an employee for the least cost. The design is particularly focused on maintaining the involvement of the patient in the purchase decision.

Description of Plan Benefits
$10.00 for Preferred Generics
$20.00 for Preferred Brand Name and Preferred higher priced Generics
$40.00 for Preferred Brand Name and Preferred higher priced Generics
Special discount pricing on all Non-Preferred Drugs
Target Markets
The list of types of organizations that may benefit from the Optimum HealthCard’s Plan is extensive. In fact, any company that has determined it is prudent to cease self-insuring the prescription benefit and insulate itself from the risk of increasing costs is a likely candidate. Any company that has been reluctant to offer a prescription benefit because of the tremendous cost of a comprehensive program is also likely a candidate. In addition, we have identified the following:

Worksite companies
Professional Employee Organizations (Leased employee companies)
Companies with large segments of part time or other groups not qualifying for comprehensive group medical benefits
Any groups not offering comprehensive group medical
Groups that have determined they cannot afford to offer full group medical or who wish to carve the Rx out of the medical risk
HMO’s and other managed care organizations desiring to carve out the prescription benefit but who still need to integrate the prescription data into its other information.

Industry Trends Although we are all aware of the increasing costs associated with prescription benefits, there is also good news. It is now possible to design a solid and valuable benefit primarily using far less costly generic drugs.
Another factor is the incredible amount of direct-to-consumer advertising that has been expended by drug manufacturers. Spending on consumer advertising has increased from $55 million in 1991 to over $2 billion. This trend has resulted in consumers specifically requesting physicians to prescribe the advertised and frequently expensive medications.

There are three key factors that have contributed to the escalating costs of prescription drug programs:
Wholesale inflation cost. Manufacturers continue to impose price increases. Although material, this factor alone is moderate in relation to the other two factors. Of greater impact is the far larger cost of newer drugs contributing to price inflation.
New drugs treating conditions previously not treated with medication. There are many new drugs that are used to treat conditions that previously required other, more expensive medical treatment. There are also many new drugs, much more expensive than existing therapies that only offer marginal therapeutic improvement to existing treatments. The former segment of this category has contributed greatly to our health, while we struggle to deal with the value of the second segment. Over 50% of the nation’s medication costs are represented by some 50 drugs introduced in just the past ten years or so.
Better medication compliance. More people are more accurately following the directions to take their medications properly. Twenty years ago, over fifty percent of the prescriptions dispensed were not refilled as prescribed. Today, people are much more aware of the need to comply properly with the medication directions. This has resulted in a rapid increase in the amount of medication used by each plan participant. It also contributes to a better healthy condition. For brand and generics, people are consuming about 12 prescriptions per year today vs. only 8-9 just a few years ago. People are better at taking medication the way they should be taking it.

In today’s world, not everyone can afford and not everyone desires the best and most comprehensive prescription drug plan.

So many of the patents protecting branded medications have expired that it has become possible to develop a prescription benefit plan consisting primarily of generic drugs.

Frequently Asked Questions
Where can I use the card?
The Optimum HealthCard is accepted at over 50,000 pharmacies throughout the United States. The network includes pharmacy chains, such as CVS, Rite Aid, Target, Walgreens, Wal-Mart, and more, as well as thousands of independent pharmacies throughout the country. Pharmacy location information can be obtained by contacting customer service. If a neighborhood pharmacy is not already participating in our network, please have them call us. We will send them information about how then can participate in the network so that you can take advantage of the savings as soon as possible.

What if my pharmacy doesn't recognize the card?
Pharmacies may not be familiar with every prescription program in which they participate. If the pharmacist does not recognize your Optimum HealthCard or if you encounter a problem at the pharmacy, DO NOT leave without having the pharmacy call the toll-free number printed on the ID card.

What is my average discount on Non-Preferred Drugs?
Members are currently receiving an average discount of approximately 19% on brand name drugs. There is no guaranteed percentage savings on every prescription purchase. The price paid depends upon the pharmacy and the type and quantity of drug purchased. Pharmacies, just like other retail stores, compete against each other and may have special prices on some products. When this is the case, we cannot discount the pharmacy's already low price, but a member will receive the advantage of the pharmacy's special pricing. THE MEMBER ALWAYS RECEIVES THE LOWER OF THE OPTIMUM HEALTHCARD CONTRACT PRICE OR THE PHARMACY'S PRICE.

What is a generic drug?
Once a patent on a brand name drug expires, other drug companies may make a generic version of the drug, with the approval of the Food and Drug Administration (FDA). The FDA's standards for quality are the same for all manufacturers. This means the generic drug contains the same active ingredients as the brand name whose patent has expired, and that it’s as safe, potent and effective.

How can I keep my prescription drug costs down?
The use of generic prescription drugs, whenever available, is most cost effective. Don't be shy - discuss your prescription options with your doctor. Ask whether an alternative, less expensive option would work for your condition.

How will I know if there's a generic equivalent available?
Simply ask your local pharmacist or call Optimum HealthCard 's Customer Service Department to find out about generic equivalents for your prescription. Also ask your doctor to prescribe generics whenever possible and appropriate. (Your enrollment packet will include helpful materials you can share with your doctor.)

What is the difference between brand name and generic drugs?
The brand name is the trade name under which the product is advertised and sold, and is protected by patents so that it can only be produced by one manufacturer for a pre-determined number of years. Once a patent expires, other companies my manufacture a generic equivalent, providing they follow stringent FDA regulations for safety.

Generic drugs are drugs for which the patent has expired, allowing other manufacturers to produce and distribute the product under a generic name. Generics are essentially a chemical copy of their brand-name equivalents. The color or shape may be different, but the active ingredients must be the same for both. The preferred drug list contains only FDA-approved generic medications.

Company Overview
Optimum HealthCard administers prescription drug programs for various types of groups, including employers, insurance companies and affinity organizations such as associations, credit unions, banks, and mortgage companies. Through a contracted network of over 50,000 pharmacies, patients who are enrolled through a group may obtain their prescriptions from a participating pharmacy simply by presenting their Optimum HealthCard prescription cards.
As a pharmacy administrator, Optimum HealthCard administers the prescription part of employee medical benefits for plan sponsors and has created innovative new prescription programs for traditional insurance, managed care and uninsured participants. Electronic, real-time on-line transaction processing (OLTP) services are provided by three state-of-the-art healthcare technology companies, which allow Optimum HealthCard to be at the cutting edge of technology in integrating its services into a comprehensive EDI healthcare product.
The expertise of the Company is in administering the networks of health providers (e.g., pharmacies), the corresponding information management, and in helping package the benefits for organizations in a manner that may help such organizations meet financial and customer retention goals. All of the Optimum Health Card data bases are on line 24/7 for both the member’s and Broker needs.

Prescription Processing
Optimum HealthCard is able to provide claims processing, pharmacy networking, member toll-free call center, and clinical management services for its prescription drug programs. Optimum HealthCard offers a wide array of flexible programs that transcend the industry standard. Designed to meet a client’s needs, the distinguishing features include:
Technology Driven—leading the industry in real-time environments that offer faster access and additional information, Optimum HealthCard’s systems is state of the art fourth generation relational database structured with unparalleled ability to respond to customer need.

Unparalleled Account Management Support— Optimum HealthCard is committed to service that begins as soon as a client joins our dynamic team. Account management is the foundation of its world class customer service reputation and has been the cornerstone of its success. Empowered to be the customer advocate, Optimum HealthCard account managers lead service teams consisting of area-specific experts such as benefit design coordinators and other support personnel. Offering proactive solutions in their unique areas of expertise, the specialists team-up to develop high quality, cost effective pharmacy programs designed to support the client initiatives.

Superior Customer Service and Member Support—unlike other PBMs, Optimum HealthCard is cognizant of the fact that cardholders and dependents require decisive assistance. Optimum HealthCard provides callers with immediate and vital access to a live customer service professional instead of a “press-the-numbers” machine.

Flexible Reporting Systems—Using an advanced cache of detailed claims data, for qualified clients such as HMO’s and carriers, Optimum HealthCard offers a wide array of predefined management reports optimized to help evaluate and manage the cost effectiveness, quality, and efficiency of the selected prescription drug program. More importantly, Optimum HealthCard Account management personnel can help create a standard report package designed to meet your program’s exact needs and requirements. For unsurpassed report accessibility and information retrieval, there are currently a variety of reports available.

Member Eligibility Verification—No online claim can be approved for an ineligible (terminated or non-plan) member. If a claim is rejected with a message such as “Member Not Eligible,” the pharmacist should call Optimum HealthCard’s help desk. Our customer service representatives will verify that the member is loaded in our system, the pharmacist is submitting the correct member information (such as the I.D. number, family position or person code, and birth date), and if the member is eligible during the period of the fill date.
Pharmacy Eligibility Verification— The Optimum HealthCard goal is to provide reasonable pharmacy access for all participants. To accomplish this, Optimum HealthCard uses an "Open Architecture" network and will solicit the enrollment of any pharmacy or chain of pharmacies not already participating. There is no enrollment fee for these pharmacies to join the network and no software upgrades required if the pharmacy has adhered to national standards. Optimum HealthCard’s Provider Network is made up of both major national chain pharmacies and thousands of independents.

Generic Substitution— Optimum HealthCard supports mandatory substitution and edit programs where the benefit underwrites both brand and generic medications. If the benefit parameters are set up to require generic substitution, the pharmacy will receive an online message when processing the claim such as “use generic” or “substitute with ____.” To ensure pharmacy compliance, the requirement to respond online to some or all DUR edits, as well as the edits that can be overridden at the pharmacy level, are determined by the plan.
Benefit Design Edits—Currently, Optimum HealthCard system supports approximately 1,500 different benefit designs. For maximum flexibility, there is no limit to the number of different benefit parameters that the system can support including: varying co-payments and deductibles, maximum days, maximum quantity, benefit limitations, and benefit eligibility. Benefit amounts are reset on the benefit anniversary or plan year, quarterly, monthly, or as required.
Pricing Adjudication—traditionally, reimbursement rates are AWP less a percent discount plus a fill fee; generic reimbursement rates are the MAC price plus a fill fee. Other discounts or fill fees incentives may be applied depending on the needs of the plan and applicable state regulation.

Adjudication of Compound Claims—When a claim for a compounded medication or intravenous infusion therapy is received, a system flag overrides the AWP discount calculations, and the prescription pays the amount billed by the pharmacy, plus the applicable dispensing fee, using special adjudication codes.


Dependable Customer Service
Optimum HealthCard is cognizant of the fact that callers require decisive assistance. Our approach to customer service transcends the industry standard—we provide your callers with immediate and vital access to a live customer service expert instead of a “press-the-numbers” machine. In addition, we use industry experts to staff our help desk.
Our knowledgeable Help Desk and Customer Service department ensures that all physician, member, and pharmacy calls are responded to swiftly and accurately. Our prompt customer service help desk is available toll free from Monday through Friday—7:30 a.m. to 9 p.m. (Central time)
In addition, for immediate twenty-four hour support and assistance, our Customer Service department has an interactive voice mail recording system. Year round, members, physicians, or pharmacies calling in after hours receive detailed instructions for paging an on-call customer service supervisor who immediately provides solution-oriented assistance.

Optimum HealthCard’s Customer Service department ensures that all calls are responded to at the fastest level of response time in the industry. To maintain our commitment to excellent customer service, our performance goals are as follows:
maintain an average speed of answer (ASA) within 60 seconds
call abandonment rate averages 5 percent or less
Meeting or exceeding these requirements, Optimum HealthCard’s representatives currently:
answer 90 percent of all calls within 20 seconds
operate with a call abandonment rate of less than 3 percent and a blocked call rate of less than 1 percent
Optimum HealthCard’s CSRs accomplish their duties using our on-line real time program. Our experienced customer service staff has easy access to online information through their computer terminals and provides immediate assistance. Currently, less than two percent of received calls require call backs or additional research. The system allows our CSRs to immediately view:
member, physician, and pharmacy eligibility information
coverage and exclusion tables for benefit edits, restrictions, and formularies
pricing information for carrier pharmacy network
eligibility coding in comprehensive member maintenance screens
online concurrent DUR messages being sent back to the pharmacies as claims are processed
drug file information from First Data Bank


Eligibility
Optimum HealthCard’s synergistic approach to member, eligibility data transcends the industry standard. In addition to instantaneous real-time access to our system, we offer a wide array of specialized eligibility data support. For example, due to the flexibility of our advanced systems, we can accept eligibility information and data in a client’s file layout—we are happy to map your eligibility information to our system specifications. Eligibility information can be submitted on any plan specified frequency including daily, weekly, or monthly in your preferred format— EDI transmission, data tape, online, etc.

ID Cards
when member additions are received from the plan, eligibility information is immediately loaded into the system. This triggers an automatic tag for card production. Using eligibility information provided by a plan, ID cards can easily be customized with your organization's logo and a specialized text message. Optimum HealthCard’s ID cards typically contain the following information:
Plan/company name
Carrier ID number (to be assigned upon implementation)
Member name
ID number
Person code 

Following the initial distribution of the cards, we print cards for new ads and/or lost or stolen cards on a daily basis. Once the cards are reviewed for both print quality and accuracy, they are either shipped to the client for distribution or mailed directly—along with peripheral materials—to the member.