Employer Group Saves $1.8M on Specialty Drug Costs
Reveal up to 30% in pharmacy savings.
Self-Funded Employer Group
An employer group faced unsustainable pharmacy costs due to specialty medications for a handful of members with a specific hereditary condition. Navion provided creative guidance and leveraged external resources to design a solution that significantly reduced costs, preserved staffing levels, and improved the group’s PBM contract terms.
Client Profile
Challenge
Despite a long-standing relationship with their PBM, the employer was not receiving proactive solutions to address their growing specialty drug costs. The PBM’s pricing was uncompetitive, as they had not faced a market analysis in years. Claims for the high-cost specialty medications were targeted to be lasered, further exacerbating financial pressures.
Expertise
Navion conducted a detailed analysis of the group’s pharmacy utilization and worked with third-party vendors to craft a customized solution. By carving out the specialty medications and utilizing manufacturer assistance programs, we reduced costs significantly. Navion also performed a year-long audit to evaluate the PBM’s effectiveness and renegotiated the contract to secure better discounts, enhanced rebates, and removed unfavorable exclusions.
Impact
Through Navion’s efforts, the employer group achieved $1.8 million in annual savings, preserving jobs and reducing financial stress. The new contract terms included improved discounts and rebates, providing long-term value while ensuring that specialty medications were covered effectively without straining the budget.
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Cost-Containment Solutions
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