RFP Process Helps Reduce Pharmacy Benefits Costs

Pharmacy Services Case Study

The Request

Reduce costs for pharmacy benefits program, including commercial, Medicare Part D and ASO lines of business.

Company Profile

Industry: Pharmacy Services

A large health plan customer of Brown & Brown’s Pharmacy team wanted to reduce its costs for its overall pharmacy benefits program, including commercial, Medicare Part D and ASO lines of business. The customer requested the Pharmacy team to complete a focused RFP/market check to evaluate selective pharmacy benefit managers (PBMs) and determine if better services and pricing were available in the marketplace.

The Solution

Created a custom RFP process that included a complete financial analysis for all lines of business and a focused 25-question qualitative questionnaire.

Brown & Brown’s Pharmacy team completed a custom RFP process that included a full financial analysis for all lines of business, developed a 25-question qualitative questionnaire that focused on five main areas of interest and evaluated the responses within the questionnaire.

This entire process was completed within a six-month timeline, as the customer needed to quickly meet a year-end deadline.

The Results

The health plan renegotiated 8.25 percentage points better overall on its commercial contract and 11.6 percentage points better overall on its Medicare Part D contract.

The results of the RFP process provided an opportunity for the health plan to renegotiate 8.25 percentage points better overall on its commercial contract and 11.6 percentage points better overall on their Medicare Part D contract.

In addition, the PBM provides rebates for the Medicare Part D program, and the Pharmacy team assisted the health plan to gain almost $260 more on average per brand claim than what the health plan was receiving previously. Lastly, the team assisted the customer with renegotiating the terms of their contract and was instrumental in revising and including additional language to further protect the customer from unexpected shifts in guarantees, clarify calculation methodologies and right-size how guarantees were calculated based on ambiguous caveat language.

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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.