Case Studies

Case 1 – Hospitality Management Co.

Rx Cost Per Month Per Member

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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.

Approach

  • 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.

Approach

  • 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.

Approach

  • 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.