Health Plan Pharmacy Cost Controls
Case Study
The Request
Drive cost savings to the health plan through a Pharmacy Benefit Management vendor evaluation
Company Profile
Industry: Commercial and Medicare Lines
Covered Lives: 180,000+
A regional health plan in the Northeast region of the United States, with over 180,000 covered lives across Commercial and Medicare lines of business, had not competitively marketed its Pharmacy Benefit Management (PBM) vendor in many years. The health plan wanted to determine if they were partnered with a PBM vendor that could meet their needs and if their agreement offered the most aggressive financial pricing for their member’s drug purchasing.
The Solution
Brown & Brown provided a market check with financial benchmarking, leading to a longer-term Request for Proposal (RFP) and PBM strategy
Brown & Brown performed an initial market check of the PBM agreement in place. This provided financial benchmarking across all financial areas of the contract, along with a negotiation for a contract extension that allowed time to perform a full Request for Proposal (RFP) process.
Brown & Brown focused on strategic and financial aspects of the PBM relationship to help ensure the vendor partner complements the health plan’s overall strategy and provides a market-leading financial arrangement and program offering.
The Results
The analysis provided almost 20% in overall savings and determined a suitable PBM
The results of these exercises included the following:
- $18M (6%) in pharmacy savings over the one-year market check term
- $45M (13.8%) in pharmacy savings over the three-year RFP term
The RFP did not result in a vendor change, so the results were achieved without disruption to the business or need for an implementation process.
Ready to help minimize your risk and uncertainty?
Contact us for more information.
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.