Pharmacy Benefits Plan Cost Reduction

Pharmacy Services Case Study

The Request

A community-based health plan was searching for an updated and more competitive PBM.

Company Profile

Industry: Pharmacy Services
Employees: 33,000+
Regions: Southeast

A Southeastearn, community-based health plan with approximately 33,000 Medicare and Commercial lives sought an updated and more competitive contract with its current pharmacy benefits manager (PBM). A market check was not performed after year two of the contract, and the contract was no longer competitive compared to the marketplace after the completion of year three.

The Solution

Performed a market check based on the customer’s current contract.

The health plan retained the Brown & Brown Pharmacy team to perform a mid-contract market check. Based on the existing scope of the health plan’s contract language, the Pharmacy team utilized its proprietary database to evaluate the pricing and contract terms of customers similar in size, scope and demographics to the health plan.

The Results

The market check resulted in $9 million (12 percent) savings over the remaining contract term.

The Brown & Brown Pharmacy team collaborated with the health plan to understand its unique needs and requirements. After completing the market check, the Pharmacy team was well-positioned to recommend optimal contract audit and reconciliation methodology language as well as competitive pricing opportunities. The market check resulted in $9 million (12 percent) savings over the customer’s remaining contract term.

The health plan continues to utilize the Brown & Brown Pharmacy team’s consulting guidance and auditing practice to help keep its pharmacy benefit contract performance transparent and competitive.

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DISCLAIMER: Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview of the topics and services contained herein. Brown & Brown, Inc. and all its affiliates, make no representation or warranty as to the accuracy or completeness of the document and undertakes no obligation to update or revise the document based upon new information or future changes.

DISCLAIMER: Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview of the topics and services contained herein. Brown & Brown, Inc. and all its affiliates, make no representation or warranty as to the accuracy or completeness of the document and undertakes no obligation to update or revise the document based upon new information or future changes.