Troy Medicare is an NC-licensed health insurance company that puts pharmacists in the driver’s seat of every senior’s healthcare. The average senior visits one of our 21,000 pharmacies 3 times per month. We are the first health plan that leverages these interactions and enables pharmacies to improve health outcomes and drive down health costs.

Drug Pricing Transparency

Troy Medicare is the first Medicare Advantage plan to bring transparency to drug pricing. In early 2019, Troy Medicare signed an agreement with its pharmacy benefit manager (PBM) to use the National Average Drug Acquisition Cost (NADAC) as the basis of reimbursement for all of its members’ prescription. By using the publicly available NADAC pricing standard, Troy Medicare enables pharmacies and patients to know with 100% certainty what the price of each medication is ahead of time.

  • We reimburse pharmacies for clinical services ($360 – $600 per member per year) for care management that measurably reduces healthcare costs.

  • No big-box healthcare, no mail-order, no hidden (DIR/GER) fees. We are the first Medicare Plan to adopt the NADAC transparent drug pricing standard.

  • No unnecessary prior authorizations and denial letters for services performed already

  • Troy Medicare provides actionable data insights at each healthcare touchpoint. We are the first Medicare plan to connect physicians to pharmacies, social workers, nurses, labs, and the patient’s own devices.

Enhanced Service Networks

In the past 2 years, thousands of community pharmacies in the U.S. have joined together to form “enhanced service networks.” Community Pharmacy Enhanced Services Network (CPESN) is an example of such a network that started in North Carolina by Community Care of North Carolina (CCNC). CPESN is a clinically integrated network of community pharmacies that coordinates patient care with broader care teams to provide medication optimization activities and enhanced services for high-risk patients.

Together, we found that community pharmacies were able to reduce readmissions for complex care patients by 45% and reduce emergency room visits by 15%. Additionally, patients were 25% more likely to engage their physician and 20% more adherent to their medications.

Here are the actions our community pharmacies take every day to address Chronic Care Management on a regular basis:

  • Review a patient’s medications

  • Review a patient’s disease states

  • Review a patient’s most recent provider notes

  • Review a patient’s labs (including vital signs)

  • Discuss vaccines

  • Review OTC med list

  • Discuss nutrition and physical activity

  • Create a care plan

  • Document each interaction

Timeline

  • 2018

    2018 – Started

    2018 – Started

    November 14, 2018

    2018 – Started with $1.2 million in founder contributions and put together a team of health insurance veterans, software engineers, and high-performing providers.

  • 2019

    February – June 2019 CMS Application

    February – June 2019 CMS Application

    February 14, 2019

    Submitting our bid for a Medicare Advantage plan in 5 counties in North Carolina: Rowan, Cabarrus, Iredell, Granville, and Robeson.

  • 2020

    2020 – Year 1 Operation

    2020 – Year 1 Operation

    February 14, 2020

    First year of operations with 500+ senior enrolled in our Medicare Advantage plan.

  • 2022

    2022 – Scale

    2022 – Scale

    February 14, 2022

    Scaling beyond North Carolina into strategic countries where our pharmacy relationships are

  • 2025

    2025 – IPO

    2025 – IPO

    March 5, 2025

    We plan on breaking even in our third year and IPO-ing as early as 2025 by reaching over 111,000 members

FREQUENTLY ASKED QUESTIONS

No, Troy Medicare is a Medicare Advantage plan. Troy Medicare covers Part D, but it also additionally covers the doctor and hospitals bills for a patient. By managing the patient’s entire health, we can share meaningful health savings with the pharmacies and physicians that drive down health costs for each patient.

Troy Medicare was started in 2018 by Flaviu Simihaian, Josh Young, Pharm D, Amina Abubakar Pharm D, and Joe Moose Pharm D. Now, over 40 pharmacy owners, physicians, and healthcare professionals have invested in Troy Medicare, making it the only Medicare Advantage plan to have over 50% ownership by community pharmacies.

Absolutely, you can contact us at info@troymedicare.com.

We are in the middle of the CMS application process to be live in Iredell, Rowan, Cabarrus, Granville, and Robeson counties in North Carolina next Open Enrollment (2019). After that, we plan to expand quickly to more counties and states.