The Secret to Successful Retiree Prescription Benefits: An Employer Group Waiver Plan (EGWP) from a Knowledgeable Pharmacy Benefit Manager (PBM)

Jun 25, 2020 3:34:00 PM

Providing health and prescription benefits to retirees can sometimes be overwhelming for employers to manage, especially in an ever-changing regulatory environment. Adding to the challenges, the senior citizen population is continuing to grow, chronic conditions are becoming more prevalent and pricey new drugs come to market every day.

While there are options for managing retiree prescription benefits, an EGWP provides plan sponsors an opportunity to reduce retiree drug costs through additional federal and manufacturer subsidies and tax advantages. These savings aren’t available when utilizing commercial coverage for retirees—even if you are taking advantage of the Retiree Drug Subsidy (RDS). Considering a PBM with an EGWP can be more advantageous, helping you truly maximize potential savings.

EGWPs Improve Cash Flow and Shift Payer Responsibility

  • Manufacturers pay 75% of the cost of brand drugs during the coverage gap, reducing costs for both plan sponsors and members
  • The Centers for Medicare and Medicaid Services (CMS) provides subsidies for 80% of eligible drug costs that exceed the maximum true out-of-pocket cost levels during the catastrophic phase, decreasing the plan liability to only 20%
  • Subsidies from CMS are paid directly to the plan monthly, without completing complicated applications, to proactively improve cash flow

Save Money without Sacrificing Benefits or Complicating Administration

EnvisionRx offers EGWPs that can mirror your current employee benefits, with flexible funding options and responsive customer support. You can take advantage of all of the available savings and subsidies an EGWP offers and get the prescription benefit and Medicare expertise to make administering the benefits a breeze, as we handle all interactions with CMS for you.

Regional Labor Union Saves Nearly $700K by Switching to an EGWP from EnvisionRx

egwp_casestudy rds graphic

1 Includes 1,095 members | 2 11.5 months used to calculate annualized costs
The above demonstrates one client's savings based on their plan and member base. Please note that this is by way of example only and does not reflect any guaranteed savings, as your plan's experience may vary.

Turn to Your PBM to Care for Your Retirees’ Prescription Needs

An EGWP can provide savings and subsidies that make providing retiree prescription benefits more affordable and lessens your financial risk. Partnering with a PBM to administer the EGWP provides unmatched prescription benefit expertise. However, many PBMs do not offer EGWPs. EnvisionRx can provide all the perks an EGWP offers, with the prescription and Medicare expertise you need to meet your plan and member needs. That’s a win-win that spells success.

Topics: Solutions & Best Practices