Case Study: Pharmacy Benefit Management

It’s no secret that over the last few years, prescription drug costs have skyrocketed and the out-of-pocket expense for families now averages about $1,200. And, that’s just average. If there are chronic illnesses, that cost can jump dramatically. Employers are feeling the pinch too as they try to control costs to maintain benefit plan quality for their employees.

Client Background

A health care provider client has approximately 170 employees. Over the last few years, they’ve moved from a fully-funded plan and joined InCap®, our medical group captive, which lowered their health care premiums.

The Challenge

They have consistently had more than a dozen large loss claimants, comprised of employee, spouses and dependents, which required long-term need for specialty drugs along with the protocol of treatment for those individuals with chronic illnesses.

The Solution

We recommended the implementation of a Pharmacy Benefit Management program which would provide savings for both the employer and employee.

As a result, they have realized savings of:

$66, 245 from special additional value savings – saving them and their employees substantially on specialty drugs.

They have also received rebate checks that previously would have remained with the carrier. Those amounts for 2018 are:

  • Q1 – $7,623.87
  • Q2 – $10,387.57
  • Q3 – $9,005.60
  • Q4 – $7,147.10

Total:  $34,164.14

To learn more about the benefits of a PBM, contact us.