Troy Medicare Brings Transparency to Medicare Advantage

CHARLOTTE, N.C.--(BUSINESS WIRE)-- Troy Medicare, a Charlotte, North Carolina-based startup Medicare Advantage plan, announced today that it has signed an agreement with its pharmacy benefit manager (PBM) that brings greater transparency to drug pricing. Launching in five counties in North Carolina in 2019, Troy Medicare uses data and technology to streamline payments, minimize hassle, and empower providers.

“We are a team of health insurance veterans, software engineers, and high-performing providers,” said Flaviu Simihaian, CEO of Troy Medicare. “This competitive advantage enables us to reduce the administrative burden for the hospitals, doctors, and pharmacies in our network so that they can focus 100% of their attention on providing care to Troy Medicare members.”

“Drug pricing today lacks transparency due to most PBMs hiding the true cost of medications behind rebates, kickbacks, and hidden retroactive clawbacks,” said Josh Young, pharmacy owner in North Carolina and investor in Troy Medicare. “Troy is the first Medicare plan to use a transparent pricing model called NADAC (National Average Drug Acquisition Cost), which is published weekly on the Medicaid website. This level of transparency allows patients to know the exact cost of each medication before they show up at the pharmacy. This is truly revolutionary for providers and seniors across the country.”

As a Medicare Advantage plan, Troy Medicare receives a capitated payment from the federal government and is responsible for the full cost of care of its members. The company is focused on the rural communities across the United States where pharmacists and physicians are the core of each member’s healthcare decisions. Troy Medicare has assembled a network of hospitals, doctors, and pharmacies who have proven to meaningfully reduce health costs for members in their community. By reducing these providers’ administrative burden and empowering them with world-class data and technology, Troy Medicare’s network of hospitals, doctors, and pharmacies have proven to meaningfully reduce health costs for members in their community.

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