Case 1 – Hospitality Management Co.
Hospitality Management Company located in Texas were contracted with a large, well know Pharmacy Benefit Management Company through their National Broker. Rx costs had continued to accelerate despite reported improved contracting and co-pay adjustments. The group had about 1800 employees and a net Rx plan cost just under 1.1 million per year.
- Contracted with a PBM flexible enough to focus on lowest unit cost.
- Negotiated guaranteed rates on carefully defined brand and generic components.
- No change in co-pay structure for brand and generics and added a $2 co-pay tier for medically sound voluntary
- OTC switch choices and focused generic cholesterol switches.
Results: First year’s total drug spend dropped $178,000 for a savings of 18.5% over previous contract.
Case 2 – Mid-Size Company
A company based in Chicago with about 1600 employees was utilizing an integrated plan with a major insurance company. For a variety of reasons, they did not want to change carriers and only wanted to make sure they were receiving fair pricing.
- Evaluated current Rx usage and discounts and determined pricing to be unacceptable.
- Negotiated increased discounts from the carrier despite their claim of a “transparent” program.
- Co-pay structure for brand and generics remained unchanged.
Results: First quarter savings from greater Rx discounts exceeded $82,000.00 representing 7.2% with NO PLAN CHANGES.
Case 3 – County Government
A County Government in Illinois with 325 employees had been with a small PBM for a number of years. While the group was not unhappy with service overall, the program had not been updated for nearly a decade. Net plan cost was running over $600,000.
- Obtain a claims file of all Rx activity for the most recent 12 months.
- Sent out an RFP for PBM activities including re-pricing information on claims file.
- Maintain same co-pays and benefit structure.
Results: New PBM put in place with improved discounts resulting in OVER $100,000 in annual savings with no change in benefit structure.