Move to Self-Funded
Reveal up to 30% in pharmacy savings.
Overview
A 3,000-life group transitioned to self-funded benefits, leading to nearly 50% savings over 3 years.
Client Profile
Challenge
Rising Healthcare Costs: The group struggled with unsustainable expenses under a fully insured model, prompting the need for a more cost-effective solution.
Limited Savings Opportunities: Existing strategies failed to uncover significant cost-saving measures, particularly in areas like rebates and specialty drug spending.
Specialty Drug Costs: High-cost specialty medications created financial strain for both the plan and its members, requiring innovative cost-containment strategies.
Formulary Management: The lack of a restrictive formulary made it challenging to control costs effectively while ensuring access to necessary medications.
Network Accessibility: Ensuring access to an affordable and expansive pharmacy network was critical to meeting member needs and minimizing disruption during the transition.
Expertise
- Running a PBM RFP, saving $6M immediately
- Uncovering additional savings through rebate program oversight
- Implementing a specialty copay maximizer to lower costs for the plan and patients
- Opting for a restrictive formulary for further savings
- Leveraging a 55K pharmacy network to ensure affordable access to medications.
Impact
Nearly 50% (49.75%) savings over 3 years
Navigate Rx benefits with clarity and confidence.
Cost-Containment Solutions
Best-in-Class Rx Contracts
