Who Is Eligible To Join the NPCC?

All Health Plans can join the NPCC, including corporate, union and municipal health plans, as long the Health Plan is providing prescription coverage to at least 5,000 covered lives.

Who Can Benefit From Joining the NPCC?

We guarantee that every Health Plan will benefit from joining the NPCC.

Using the most knowledgeable experts in the nation, we have negotiated airtight PBM contract terms that are designed to ensure that our Coalition Members receive the best prescription services and lowest cost pricing that is available in the nation. The Coalition’s experts will also provide regular and continuous services to ensure you are able to control your costs and address new developments in the marketplace.

What Services Will Coalition Members Receive?

Relying on our experts’ knowledge – and Contract terms that require your new PBM to provide us with a complete set of your claims data every month – our experts will continuously review your claims data to try to identify problems as they arise.

Also, relying on the Contract terms we have obtained that allow our experts to meet monthly and quarterly with PBM representatives, our experts will, among other matters: (i) continuously monitor and update pricing for newly available generic drugs and new-to-market specialty drugs; (ii) review proposed changes to your Formulary; and (iii) evaluate the effectiveness of Savings Programs you have implemented. And then we’ll communicate with your Health Plan to discuss why it might be wise to make certain changes in your prescription coverage program.

Moreover, relying on our Contract terms that allow the Coalition to renegotiate certain guarantees quarterly – and other guarantees and Administrative Fees annually – our experts will ensure that our pricing terms and guarantees are continuously improved. Plus, our contractually binding Administrative Fee structure will enable your Administrative Fees to decrease automatically, as the Coalition grows in size.

Our Contract terms also include extremely detailed provisions that will ensure that our experts will be able to conduct thorough audits of each Coalition Member’s coverage. And all audit work will be provided for free, as part of your Coalition Membership.

All Health Plans will also benefit from regular conference calls that we will conduct to update all Health Plans about new industry-wide problems that are emerging and to provide our recommendations as to how to address these problems, as well as to share insights on Best Practices.

Can A Health Plan Customize Its Prescription Coverage Program?

Every Health Plan that joins the NPCC will be able to customize its own Benefit Plan design:

  • Health Plans can choose a standardized formulary or customize their own formulary.
  • Health Plans can also implement all Savings Programs – or no Savings Programs – or select those that they want and not implement others.
  • Moreover, in connection with each Savings Program, Health Plans can choose how to implement the Program. For example, Health Plans can choose which drugs to include in a Prior Authorization or Step Therapy Program. Or how their Mandatory Generic Program will operate, and for which drugs.
  • Health Plans can also determine whether to include quantity limits on certain drugs, which drugs to apply limits to, and the quantities to be allowed in connection with each drug.
  • Health Plans can also determine whether new-to-market Specialty Drugs will automatically be covered, or only covered after the Plan specifically approves coverage in writing.

In connection with each of the above choices – and many others too – our experts will provide your Health Plan with extensive guidance.

Can A Health Plan Change Its Benefit Plan Design After It Joins the NPCC?

Our Contract allows Health Plans to implement their own Benefit Plan Designs – and Formulary and Savings Program choices – before their Effective Dates, and change all of the above periodically thereafter. And regular conference calls between our Coalition experts and Coalition Members will enable Health Plans to consider how best to take advantage of the opportunity to do so.

What Does It Cost to Join the NPCC?

There are no up-front fees to join the NPCC.

Moreover, if your Health Plan wants our experts to conduct a financial analysis to determine your probable savings from joining the Coalition, we will do so for a very small fee to cover our costs.

After joining the Coalition, each Coalition Member will be charged a monthly fee – based on the size of the Coalition Member – to fund all activities that are performed on behalf of the Coalition and each Coalition Member. This Coalition Member Fee is purposely designed to be less than the costs that your Health Plan would incur to conduct your own PBM RFP and an annual audit.

By joining our Coalition, your Health Plan will not only obtain each of the above services for free, it will also benefit from the continual and ongoing services that the Coalition will perform on behalf of your Health Plan.

If I Join the Coalition, Am I Locked Into Membership For A Long Period?

The Coalition is well aware that in this uncertain and ever-changing environment, many Health Plans do not want to make any long-term commitments.

Accordingly, our Contract terms allow any Coalition Member to sever its relationship on 90 days notice. Our Contract terms also contractually bind the PBM to assist every Coalition Member in transitioning to an alternative vendor.