Capital Rx has unveiled Capital Equilibrium, a new level-funding pharmacy benefit management offering.
The program leans on an A-rated stop-loss carrier for reinsurance as well as Capital Rx's PBM services to provide a fixed monthly payment plan that covers anticipated claims, administrative costs and stop-loss. The pricing is often below market rates, according to the announcement.
The stop-loss insurance manages claims that exceed monthly limits, while the PBM piece is built on a "fair" pricing structure that eschews traditional discounts and rebates, Capital Rx said.
Plan sponsors in all 50 states can sign on with Capital Equilibrium, according to the announcement.
Mike Miele, senior vice president of insured services at Judi Health, the parent company of Capital Rx, said in the release that the model is designed to be transparent and makes clear what rebates are being passed through.
“This is a very price-sensitive market, and we believe that Capital Equilibrium is the most competitive and flexible level-funded solution,” Miele said. "There are so many ways we can craft this and work with employers—that’s a true benefit.”
Plan sponsors that select Capital Equilibrium will also have access to individualized client reporting and the ability to opt into a risk-sharing program that can help mitigate gains and losses related to the stop-loss coverage, according to the announcement.
Clients can also secure a potential refund or rate credit at year-end if claims figures are better than expected, the company said. Plan members will also be able to reach out to a 24/7, multilingual call center if they need assistance or support with their coverage.
“The skyrocketing health insurance premiums we’re seeing across the country are in no small part due to rising spend on the medicine people need,” said Justin Leader, president and CEO of BenefitsDNA, a Pennsylvania-based employee benefits advisory, brokerage and consulting firm, in the press release.
"We’ve reached a breaking point," Leader said.