OTC benefit program setup
We work with statewide and provider-sponsored Medicare Advantage, as well as smaller niche plans to facilitate OTC benefit implementation and management for them.
We make it simple for health plans
OTC Stores takes care of everything: from advisory to further order fulfillment and reporting at no setup and administration fees.
Collect
Choose your benefit population, amount allocated, and membership benefit frequency.
Analyze
Share data for benefit customization: targeted health conditions or a problem you want to address.
Brand
Send the health plan's branding guidelines for design customization of your white-label solution.
Act
Get the new OTC benefit program delivered to your membership: exceptional care in a timely manner.
Report
Get 24/7 access to any reports: from financial to CMS. Actionable reports for easy change management.
We are customizing all the aspects of an OTC benefit
Configurable benefit
A health plan determines, and OTC Stores may advise on benefit allowance, frequency, rollover rules, and the desired limitations.
OTC Stores has a track record of simultaneously supporting multiple benefits under the same health plan.
- Product offering
- Prepaid card availability
- Supported languages
- Free shipments number
- Product limits per period
- Preferred carrier network
Reporting and billing
A health plan is billed on a weekly or biweekly basis for the items the members order.
Partnering with OTC Stores, a health plan is given 24/7 access to our 360-degree reporting portal, where you are able to track various metrics, including, but not limited to:
- Utilization and retention reports
- Transactions analytics
- Reports on most popular items
- Users metrics
- Returns reports
- Grievances and appeals reports
OTC Stores can add any report upon the health plan's request
Customized product offering
We guarantee that only CMS-approved products are featured in the OTC catalog.
Our product catalog includes a great variety of branded and generic products that meet any demand of Medicare Advantage members, including personal protective equipment and preventative care products.
Partnering with OTC Stores, a health plan can make an informed decision about including a particular medication on the list based on our expert advisory supported by analytics.
* OTC Stores constantly adjusts the products selection to meet members’ needs.
Printed product catalog
The printed catalog design is built with the specifics of the targeted audience in mind—seniors making orders by phone, and branded under the health plan guidelines.
The plan defines the languages the catalog should be available in. OTC Stores may print and distribute the catalogs to the members under a separate agreement with the health plan.
Client-oriented call center
A unique customer experience giving a heart-warming feeling of being in a caring family. Our reps educate the members on the preventive care, consult on the products and the program itself, and also work with any other information calls upon request.
We have English- and Spanish-speaking customer service representatives, additional languages can be added upon request.
Customized Webstore
Our online store ensures a user friendly experience for seniors. For each health plan, it is possible to add a credit card payment option for purchases beyond the benefit allowance or CMS-approved items.
How it works
1. Explore
With each health plan, OTC Stores discusses targeted conditions to prevent and advises on the relevant product list, benefit allowance, frequency, rollover rules, and the required limitations.
2. Select
We send a complete list of over-the-counter products with pricing, and the health plan chooses those to be included in the benefit.
3. Design
The health plan provides us with an eligibility file. We set up a reporting portal, an online store, a call center and design a printed catalog.
4. Inform
OTC Stores distributes catalogs to the members in accordance with a health plan agreement.
5. Fulfill
OTC Stores processes e-mail, phone, and online orders and delivers them directly to the members in 2–3 business days * free of charge.
6. Report
OTC Stores delivers analytics around member satisfaction, preferences, and general feedback, as well as consults on the latest industry trends to better shape the health plan offering.
* OTC Stores is able to set up its warehouses in close proximity to the member base in order to provide same-day delivery of critical items.
Setup timeline
Partnering with OTC Stores, a health plan will get a cost-effective solution, designed to increase member satisfaction, build loyalty, and grow retention.
Terms negotiation and contract signature
White-label infrastructure launch
a webstore, a reporting portal
OTC products selection
and catalog distribution agreement
Call center setup
languages, working hours, etc.
Order fulfillment infrastructure setup
Security and compliance checks
Member information exchange
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