When it Comes to PBMs, Bigger Does Not Mean Better

After Leaving for a Large PBM, This Municipality Returns to PBD for Plan Flexibility and Superior Servicing

Problem

An 1,800-life municipality group was promised massive cost savings by one of the extremely large, publicly-traded “Big 3” pharmacy benefit managers (PBM) to move their pharmacy benefit plan away from Pharmacy Benefit Dimensions (PBD).

In hopes of realizing these additional cost savings, they made the move. Not only did the group not achieve the massive cost savings promised, but they also encountered an overall lack of plan customization and a severely lacking support system. When the group needed support, they were relegated to calling an unreliable and impersonal 1-800 number with limited success. This municipality felt duped.

As pharmacy costs continue to rise, it is more important for employer groups to partner with the right pharmacy benefit manager to control benefit costs and produce positive health outcomes for their members.

While costs savings is important, it should not be the only priority when selecting a PBM. In addition to lowering prescription drug costs and improving the health outcomes for members, having a dedicated and attentive team is equally important.

Client Overview

Industry: Municipality

Group Size: 1,800

Plan Type: Self-Funded Pharmacy Benefit

Solution

As frustrations mounted with their PBM, the group knew they and their members deserved much better. That’s when the decision was made to return to a trusted partner in PBD. As a flexible, mid-sized PBM, PBD provides one-on-one servicing from the onset. With a dedicated account manager in place and a client support team established, PBD worked with the group to understand their needs and establish plan goals and priorities.

One of the first priorities was to develop a detailed and structured implementation plan to ensure a seamless transition back to PBD. The plan included an evaluation and execution of plan designs, enrollment flexibility, data exchange (claims and accumulators), quality assurance (both pre and post go-live) and developing member focused servicing to ease the transition.

While most PBMs offer various transition benefits to help ease transition disruption, PBD took additional measures to ensure a seamless transition. In addition to switching the group to PBD’s 3 tier formulary which is optimized to provide the best value at the lowest net cost, an enhanced transition benefit was put into place. This enhancement and proactive measure helped members more easily transition by working directly with the patient’s provider and providing recommended formulary alternatives to both the member and provider. The result of these measures was the perfect balance between containing Rx costs and a seamless benefit transition.

The group also expressed concerns regarding how their previous PBM charged additional fees for various enhanced plan benefits. In particular, the group expressed an interest in covering vaccine costs on behalf of their membership. Their previous PBM would only cover the cost of the drug itself, but not the cost associated with drug administration without forcing the group to pay an additional fee for this service which they treated as an add-on service.

With an inclusive drug benefit package, PBD doesn’t charge additional fees for our tremendous value-added clinical programs or clinical edits.

Results

Typically, the larger national PBMs fail to notice plan sponsors who have fewer than 5,000 employees because they do not generate significant revenue for the PBM, resulting in a lack of overall support further intensified by their unwillingness to accommodate the specific and often customized needs of many small to mid-size groups.

Frustrated with their large PBM and looking to work with a supportive pharmacy partner once again, the group came back to PBD based on flexibility and attentiveness.

Through a responsive and hands-on approach, PBD helped the group achieve its specific goals of limiting member disruption through the transition process, developed enhanced benefits with no additional administrative charges or fees, and created a new process to help further ease the transition process for their members. Having a dedicated account manager and comprehensive meant the group didn’t have to call a 1-800 number. Rather, the group had easy access in real time when they had questions or needed direct support.

In addition to the superior servicing and customization afforded to the plan, PBD was able to target interventions through clinical programs and formulary management to provide an estimated potential savings of $1.1M.

The municipality is happy to be back with their trusted PBM partner, PBD.

Questions

For more information on how you can gain greater control and cost savings on your prescription drug program, call (716) 635-3578 or email PBDSales@pbdrx.com

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Our 25 years of experience in prescription drug benefit management provides the edge you and your clients need to manage expenses now and in the future.