A Pharmacy Benefit Manager can reduce prescription drug costs and improve convenience and safety for consumers, businesses, and organizations. Pharmacy Benefits Management, or PBM, is a great way for businesses to look for savings. When working with a broker, they should find out if you have had your PBM contract reviewed. If not, bring it up to them. Reviewing your PBM contract provisions can lead to significant savings for your employees and company. Here is an example of how the Clark & Lavey team does our due diligence for our clients.
Pharmacy Benefits Management: PBM Case Study
We took on a new client, Company ABC in the food industry in Massachusetts. They were in a traditionally self-funded employee benefits plan and outsourcing their prescription program through a PBM. They had 95 employees enrolled in the plan and a handful that were taking expensive medications. Their challenge: How do you lower your expenses related to employee medications when there are limited resources for certain types of medications?
Our Cost-Saving Solution
When a new client comes on board, Clark & Lavey does a deep dive reviewing current plans and discussing alternate options, if applicable. In this instance, the prior brokerage firm had informed Company ABC that they were not eligible for certain options. We reviewed the current PBM contract and noted that there were opportunities for savings.
The Results
Company ABC decided to move to Clark & Lavey for their employee benefits. While reviewing Company ABC’s current plans, we discovered that their PBM was using an older formulary. Having found that out, we requested the PBM to run claims data through two different alternate platforms. We secured significant cost savings for our client, Company ABC, by having the PBM take the client data and run it through different formularies.
Platform 1 – When moving to one alternate platform, we discovered a potential savings of $12K. It had impacted two members. CLBSI then worked with the PBM to secure processes to steer the two members to Platform 1 and mitigate any disruption to their prescription service.
Platform 2 – When we reviewed this platform, we discovered that we could potentially save them $38K annually. One member on the current platform had a medication costing $7K/month. The move to Platform 2 significantly reduced the overall expense to the member, as well as the client, resulting in significant annual savings for all involved. And, again, CLBSI worked with the PBM to move to Platform 2 with no disruption for the member when receiving their medications.
Here’s a breakdown of savings from Clark & Lavey reviewing the PBM contract provisions:
Platform 1 = $12,000 savings
Platform 2 = $38,000 savings ($48,000 with 100% utilization – $24,000 with 50% utilization)
Overall savings = $36,000 to $50,000 annually based on potential utilization listed above
Now, would you like to see how much money we can save you? Please contact us to get started!