Selling Real Health---Getting Excited About A New Benefit
By Katherine Conner & Gary Bastie
Consider this your “Bible” to marketing a new type of program. We’ve included as much
information as possible in order to help you become proficient and successful in it. Thanks
to this publication, you’re at the right place at the right time.
Although it’s not really “new” this “new” program is just hitting its stride with the current
market. Before we begin, ask yourself this question: How long has it been since you really
became excited about your products? Often we get tired of selling what people don’t want,
that is, they want a different version of what we have yet their “version” doesn’t really
exist. Maybe it’s the price or maybe it didn’t do what they wanted it to do but you know
what I mean. As a result, both customer and Agent are frustrated from the onset. After all,
how many times can you ‘justify’ the continual price hikes for some health products or the
perceived high cost of others? Wouldn’t it be nice to have something else to offer for a
change? Wouldn’t it be nice to have something affordable that would actually exceed all
expectations? How about something people need, and want yet didn’t know it existed?
Wouldn’t that make you some sort of hero just for bringing up the subject in the first place?
New products come along all the time but usually it’s a twist on something you have already
been selling. Everyone is looking for the latest new product that will be useful to the most
customers and that has a reasonable price tag. That’s the bottom line but that’s not how
you conduct your every day business.
Maybe not until now. What if your target market was at least 45 million people, not just the
small numbers locally.
What if you could sell your program anywhere in the nation? What if you had something to
offer that people must have rather than something they might be able to use?
And, most importantly, what if people can already afford it so there’s no selling, just
education and referral? Now you’re getting the scope of this article.
Think about all the people that don’t have health insurance. That’s about 45 million people.
Some can afford it but choose to self insure instead. Others just can’t afford it and they
need help. There are millions of these potential customers right here in the U.S and in your
area. This hot political issue is all over the news 24/7.
At the same time, Employers, Associations, Affinity groups, Clubs and Unions and any other
member-based groups are looking for new benefits to offer that are attractive and cost little
to administer, or better yet have no up-front costs. What if we could put 2 and 2 together
and get 4?
So What Is It?
Here’s that “4” we got from the 2 plus 2 above: The most recent product available is not
actually insurance. It’s something else. Maybe that’s good because it lends itself to more
avenues for marketing and we’ll get to that in a while. First, consider this: your customer
1
base has a need and so do those who aren’t yet your customers. These are people that
need the newest breed of Advocacy and Patient Assistance Programs. What? Does that
mean a new and open market to millions of potential customers? Yep. The only catch is that
you need to know what’s available to these people. Maybe you’ve never heard of this kind of
program or maybe you have seen a TV ad. Maybe neither so you’re reading this article.
Here’s the latest product you can get excited about.
Free Med Programs?
Let’s investigate the Free Medication Programs. With these programs, there’s help available
for many people who can't afford their medications and do not have insurance. You mean
the huge market that you’ve never targeted? You mean the 45 million people? Yep, the
same market.
These programs, frequently called Patient Assistance Programs (PAPs), are designed to help
those in need so they can obtain their medications FREE or at a very low cost. Huh? You
heard it correctly, that “FREE” wasn’t a typo.
Each U.S. pharmaceutical company establishes its own PAP rules and guidelines so all are
going to be different in some way. All of these pharmaceutical companies have income
guidelines but they vary considerably from one company to another. Each company selects
which drugs are available on their programs and how long a person can receive assistance.
The good news is that there are over 2500 Brand name and Generic medications along with
Diabetes Testing Supplies offered through PAPs. And, they cover the most commonly used
to the most difficult to afford prescription medications. Sound too good to be true? Maybe,
but these programs aren’t new. Access is new and the information in this article is going to
be new to many of you. It gets better but there is a little red tape first.
The Red Tape
Although no two PAPs are exactly the same, most require that the applicant complete an
application form. Some programs require detailed medical and financial information. Others
require very little. Certain programs also require that the doctor complete a portion of the
form while yet others need only a signed prescription. All require a doctor's signature
however.
Once an individual fills out an eligibility application form, they will be told if they qualify for
Brand Name Free medication or Discount generic. Most programs ship the medications to
the doctor's office for distribution to the patient, while others send the medication to the
patient. Refills usually require a new application or a call to the Pharmaceutical Company
every three months to continue receiving medications. The application process can be
cumbersome and many people just give up before they get the medications they really
need.
The good news is that there are companies that can help get thru the red tape. These
companies are the providers of access or advocacy for these programs which actually
originate with the pharmaceutical manufacturers themselves. The advocacy companies are
actually like keys that unlock the door and help their customers get thru all that red tape.
2
Who is your Customer?
So, who are the customers or potential customers for these programs? Here are the facts:
Over 45 million Americans have no health insurance, and millions more have limited
coverage. Many Americans just can't afford healthcare, and, if they can, they don't have the
money to buy their medications. It's a choice no one should have to make - pay rent and
buy food or get prescriptions filled.
The keys to qualifying for any PAP are lack of medication insurance,
income and household size. Eligibility income levels start at 150% up
to 325% of the U.S. poverty level based on the number of persons within a
household. Below are the latest 2008 guidelines you can use to determine if
a group has the income qualifications:
Please Note: The individual cannot be qualified for Medicaid or other government
programs.
2008 HHS Poverty Guidelines- PPAP Income Limits
2008 FPL Poverty Guidelines
Rx Program Limits
Co-Pay Generic Maximum
*
Persons in Family or
Household
48 Contiguous States
and D.C.
Alaska
Hawaii
1
$10,400
$13,000
$11,960
$20,800
$26,000
2
$14,000
$17,500
$16,100
$28,000
$35,000
3
$17,600
$22,000
$20,240
$35,200
$44,000
4
$21,200
$26,500
$24,380
$42,400
$53,000
5
$24,800
$31,000
$28,520
$49,600
$62,000
6
$28,400
$35,500
$32,660
$56,800
$71,000
7
$32,000
$40,000
$36,800
$64,000
$80,000
8
$35,600
$44,500
$40,960
$71,200
$89,000
* Some companies will accept higher income limits
3
Free Rx at 200%
300%
Example of a patient’s monthly cost for medications
which shows you how valuable this service can be to your customers:
Condition
Drug
Dosage
Per
Day
Monthly
Quantity
Monthly
Cost
Advocate
FEE/Mo
Monthly
savings
Heart
Aldactone
25 mg
1
30
$27.63
$0
$27.63
Heart
Amiodarone
200mg
3
90
$156.00
$0
$156.00
Diabetes
Avandia
4 mg
2
60
$200.14
$0
$200.14
Heart
Coreg
6.25 mg
2
60
$116.54
$0
$116.54
Heart
Lisonopril
2.5
1
30
$13.82
$0
$13.82
Heart
Plavix
75 mg
1
30
$129.33
$0
$129.33
Reflux
Protonix
40 mg
1
30
$373.95
$0
$373.95
Cholesterol
Lipitor
80 mg
1
30
$120.62
$0
$120.62
Anxiety
Zoloft
100 mg
1
30
$84.94
$0
$84.94
Total Medication
Cost
$1,222.97
$1,222.97
Less Administrative Fee
($xxxx)
Total Costs
$1,222.97
$xxxx *
$xxxx.00
* Note: you can use this example and fill in the monthly advocacy fee to show the savings.
How do YOU Sell this Benefit?
Here is the good news you thought we’d never get to. Maybe you thought these programs
were too good to be true. They’re not and the new web technology has made resourcing
products for your customers easier and fast. Convenience for you and your customer is so
important---no one wants to waste time.
4
There are online Advocacy companies already in existence that service those that need
prescription meds and cannot afford the cost. You need to know how they work and what
you can do to sell their services. Various companies offer these services and you can
represent the program to your customers but you need to know some things first. To find
these companies remember that they advertise through Google and use keywords to attract
individuals. Many are selling to one person at a time rather than working with groups. Some
can work with large groups so you need to know there is a difference. You can work with
probably any of these providers to sell either individually or to organizations. It’s your
choice. Often those potential customers with the greatest need will be the most appreciative
of your efforts. Wouldn’t it be wonderful if you could help save lives and budgets for a
change!
So, how would you sell this program? The first step would be to educate yourself regarding
how the programs work. Then, you’d choose the right provider that you could feel confident
with and you’d go out and educate people. An educated person always seems to make a
wiser decision than one that’s not educated. If you’ve read this article to the end, you’re on
your way to knowing what you’d want to discuss with potential customers.
What’s The Cost?
What do these various programs cost? The level of service determines the cost. Most
companies charge a monthly fee but it certainly varies. Service fees range from $20 a
month for as many meds as needed to $125 a month or more. There are a variety of costs
and service levels in between.
You’d have to ask yourself what a person could afford if you were going to represent one
company over another. There are other considerations however. For example, some
services offer to send out the applications for a flat one-time fee. This could be upwards of
or exceeding $100.00. Other programs don’t have that fee. If the customer wants the
applications filled out by the service they are charged more.
Some companies will work with the customer to fill out the applications, contact their doctor
for a prescription and signature and work directly with the pharmaceutical program
submitting the original application and any renewals processes. There are services that
allow the customer to research their medications and fill out their applications online to be
printed on their home computer.
With a growing number of Baby-Boomers reaching the ages where they need medications,
this computer aspect isn’t much of an obstacle. In fact many prefer the ease at which their
computer operates and would rather not spend the time or gas doing it any other way. If
you have a non computer person, maybe you have to consider who will use one of the less
expensive online programs on their behalf before you present it to them.
Who You Gonna Call?
Most of us like to choose who we’ll work with. So, how do you determine which company
you want to work with? First, you need to know exactly what services they offer. Some are
bare bones while others offer a variety of services so you need to research and compare
first. Convenience, price and reliability are the keys to working these programs. Your
customers will want to be sure they can count on reliable information and that the service
will be easy to use. If it’s not there, you’ll certainly hear about it.
5
Convenience is a factor you need to consider. Ask any potential provider if their service
offers online and phone service to sign up. Are they responsive to the needs of their
customers if they don’t have a computer? Is there a website that’s easy to understand? Do
they offer the highest number of medications available? Not all companies offer all
medications on PAPs. These are convenience and practical considerations and a great place
to begin.
Next, there’s price. You want your customers to be able to afford the service and get the
best value for their dollar. If you offer something and they find a better deal later on, how
does that make you look? It makes you look a little greedy but, at the same time, price isn’t
the only factor. Some companies are overpriced for what they offer but that’s a value
judgment you’ll have to make once you’ve done a little research.
Again you’re doing this on behalf of your potential customers. You might as well as make it
fun because no one says it has to be w-o-r-k. Go ahead and ask the hard questions first.
You’ll discover that there are reasonable programs available for as low as $20 per month
that offer full services. A customer looking at $1200 a month for medications is happy to
pay $20 a month. Others cost more and you need to find out why. Maybe there are more
services offered, maybe not.
I think reliability and being conscientious and pro-active is another important issue. Without
those characteristics, how can your customer be sure they are truly qualified for PAPs? Does
the company offer refill assistance so your customers are receiving meds continuously or
not? If not, there’s going to be a lapse and an expensive one at that. Ask a few more
questions before you leap.
How does the company follow-up with their customers to keep them updated on the
programs offered? What kind of retention does the service have? Are they losing customers
because they cannot keep up with the volume or not available to your customers? Some
companies are just a shell service that actually wants to sign up Agents for a $300+ fee and
really don’t service the customer’s needs. Others don’t charge an Agent any signup fee but
they do care for the customers needs. You have to be diligent in your research to be sure
the company is truly a service organization. After all, as an Agent, service is often your
middle name.
When you research, be certain to check out the available websites by Googling “free
medications” or “patient assistance programs”. You will find, just by looking at a website,
that you might not want to work with a particular company. If it looks like a viable option,
dig a little deeper, ask more questions. As for websites, if you don’t understand them and
cannot navigate them or know how it works, neither will your customers. The more
complicated the process, the less someone will use it. Again, do you really want those afterhour phone calls?
You can also spend a little time calling the company owners. See if they’re accessible or if
you have to speak with a telemarketer. Go ahead and ask the questions posed above. Rate
each company by the answers you get and, if you’re adventuresome, test their service
yourself. You want to be confident the service can handle volume. That’s where the rubber
meets the road. Anyone can promise but can they produce.
6
Capacity And Commission Structures
Once you find an Advocacy company to work with you’ll want to know what their
commission structure is and how often you are paid. After all, we all like getting paid. Let’s
see how that might come into play.
Commissions might involve yet another factor. It’s in regards to how certain companies are
set up to operate on a daily basis. This aspect was alluded to above and you’ll find that
certain companies were set up like part time businesses. They can handle the onesietwosie’s but cannot handle your business volume if you work with larger groups,
associations and organizations, data bases, etc. That’s because they’ve never considered
large volume sign ups. You need to make certain you are satisfied with their
experience and abilities or you could be bringing in business they can’t handle. That means
you won’t get paid for doing all the work of bringing an organization to the table.
Other companies actively look for group volume. They possess the technology to handle a
large database of customers. Before you sign up with a company, ask, or should I say,
demand, that the services offered are in writing and sign an agreement that protects you.
You need to get all the answers to all your questions before you sign on that dotted line.
Remember, these providers aren’t insurance companies so you cannot use standard
insurance procedure here. If you’re supposed to be paid, find out how they plan to do that
and how they can track your business so you receive proper credit for it.
Actual Commissions
Since this venture will be new and unique for most Agents, there are multiple
opportunities to consider. This is the good stuff and you may have employers or
associations that you can contact who have hundreds or thousands of possible qualified
members/employees. For an example, use the assumption that you can get 100 people
qualified and signed up per month. Then, build your business from there.
With some of the more expensive programs, commissions might be quite high, say $50.00
per person, per month. With others, it’s volume driven because the sign up fees are so
much lower. Again, you’ll have to consider what people can afford and what’s best for the
customer.
Commission ranges for companies that can handle the highest volume might be in the
range of $2.00-$5.00 per member per month or as we call that in the industry, “pmpm”.
You can see from the chart below how this adds up with as little as a base of 100 sign ups
and 100 added sign ups per month. This should be easy to do if you expose the program
services to companies and associations with people in the income ranges for qualification.
That’s a hint.
Commission example is computed at the lower-end commission rate above.
7
Sales Commission
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
Month 9
Month 10
Month 11
Month 12
@ $2.00 pmpm
Total
Commission
Total
clients **
$200.00
100
$400.00
$600.00
$770.00
$932.00
$1,084.00
$1,284.00
$1,420.00
$1,548.00
$1,672.00
$1,788.00
$1,988.00
200
300
385
466
542
642
710
774
836
894
994
** assumes 75% retention of monthly sign ups over 1st year
How To Sell To Large Groups
Here are some important considerations if you wish to sell to larger groups, associations,
organizations, etc. with larger numbers of potential customers:
1) Contact employers, associations and groups related to industries that employ or
service income levels that qualify. The qualifying income levels do go up every year
and it’s easier to qualify than ever before. Self-Employed individuals are also
always looking for benefits. Think about what types of jobs rarely have benefits
available to the worker. Remember there are a lot of workers that either cannot
afford health benefits or they are not even offered to them.
For example, many food industry employees are not covered by any benefits
whatsoever. You are looking for groups of people that have a lower annual income so
refer tire kickers to this website for the May 2007 National Occupational
Employment and Wage Estimates.
http://stats.bls.gov/oes/current/oes_nat.htm#b35-0000 This will give you some
statistics of what industries you should focus on for the best result. Having
government statistics takes away the sales approach and makes it education and
informative instead. It also adds to your credibility.
8
2) You should be able to demo the website or have someone from the company
available to demo it for conference calls or meeting. If you contact a company or
organization, use a sales technique, preferably online. Use the “gotomeeting.com”
type companies for online displays with free tele-conferencing.
3) Talking points should include the low cost of the benefit, the opportunity to help
others stay healthy (employers need healthier employees) and the fact that this is a
ground floor opportunity for any organization to offer as their latest new benefit. Tell
them about the advantages of offering the benefit: healthier employees = less
absenteeism, new benefits attract members and make employees happy,
administration is easy since the service company takes care of the customer, no
upfront cost to the administrator, and the possibility of a revenue rebate back to
organizations.
Work with your Advocacy Company to obtain a discount on the monthly fees for very
large groups. Volume is very attractive to service companies that can handle it.
4) Be prepared for questions! Learn as much as you can about the details of the service
including the most common Free medications available. Most people have the same
questions regarding these programs so it isn’t difficult to answer them. Here’s a
sample of what many ask, it’s regarding the cost of the drugs that are free:
90 day
supply
TOP 20 DRUGS FREE
AVG RETAIL
Advair Diskus
Allegra D
Avandia
Cardizem
Coreg
Crestor
Cymbalta
Diabetes Supplies meter test strips
Estrogel
Humalog
Lantus
Lipitor
Lunesta
Nexium
Plavix
Requip
Seroquel
Toprol XL
Wellbutrin XL
Zoloft
$300
$315
$250
$145
$200
$290
$320
$60
$200
$250
$256
$230
$400
$400
$350
$600
$350
$82
$400
$290
5) Make sure you have documentation showing how the service works. Many people are
surprised there is such a service and hardly can believe they could offer the benefit
of FREE medications without any cost to the administrator. You can use the income
9
qualification chart above to determine how many qualified uninsured people are in
the group. Also the savings example in this article as a resource.
6) Follow-up within a week to be sure they understand the program, answer additional
questions and request a face to face meeting to discuss details of how to enroll.
Bring simple brochures or flyers that outline the steps to qualify. These are usually
available from the service company or you can copy the enrollment qualifications and
FAQ page.
7) One additional note to consider. Many member based groups want to offer benefits
that they can receive some revenue back from when they refer a new sign up. You
can offer a portion of your commission after two months of paid enrollment to make
the sale more appealing. Remember, this isn’t insurance so you CAN share your
revenue with others.
Selling Real Health…that is the bottom line for this product. You will be giving many an
opportunity to be healthier, to afford more in their budgets, and to live with less stress in
their lives. This is something everyone should get excited about. If they cannot use this
type of benefit, they know someone who can. That’s a huge market and it’s for all the
right reasons.
10