A large Indianapolis-based employer with 16,000 covered lives across the U.S.
The client had been experiencing steadily increasing costs of Rx claims with most recent annualized pharmacy claims of $11,800,000 for its plan members.
After reviewing the language of the pharmacy benefit management (PBM) contract that determined the terms and cost variables, savings opportunities were identified without changing any benefits to employees. Innovative Rx Strategies negotiated higher discounts and reduced dispensing fees while gaining a significant increase in the share of pharmaceutical manufacturer-derived revenues for plan members. Importantly, improved contract terms were negotiated including leveraging discounts available during the deductible and coinsurance periods.
The client saved $3,000,000 to its Rx benefits plan in the first year with no change in benefit design or disruption in member access to medications. The client’s employees and plan members benefited from over $400,000 in additional savings during the first year based on the improved PBM contract terms.