Troy Medicare Receives Health Insurance License in NC

Charlotte-based Troy Medicare , the first Medicare Plan to adopt the NADAC transparent drug pricing standard, has received its insurance license from the North Carolina Department of Insurance to offer its services in the following counties: Cabarrus, Rowan, Iredell, Granville, and Robeson.

Established in 2018 and led by Flaviu Simihaian, the company 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. Also, Troy reimburses pharmacies for clinical services ($360 – $600 per member per year) for care management that measurably reduces healthcare costs, and 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.”

Last, Troy has over 40 pharmacy owners, physicians, and healthcare professionals that have invested in it, making it the only Medicare Advantage plan to have over 50% ownership by community pharmacies.

Bottom Line: Troy has recently filed its Form D with the SEC in connection to a $2.5m debt round.