Case Study - The Value of Your PBM

How PBD Helped a Group Absorb a High-Cost Claimant While Reducing Their Overall Plan Spend

Problem

Many factors are outside of your plan’s control when it comes to managing prescription drug costs. While larger organizations can absorb fluctuations easier, a major change to a self-insured benefit plan of a small to mid-sized business can be catastrophic if not managed correctly.

A 200-life self-insured employer group recently transitioned their pharmacy benefit management (PBM) services to Pharmacy Benefit Dimensions (PBD) in search of affordable, high-quality pharmacy benefit services. When a high-cost claimant using a specialty medication arrived on their plan, they were faced with the challenge of extreme, unexpected cost increases they were not prepared to handle.

Client Overview

Industry: Property Management

Group Size: 200

Plan Type: Self-Funded, Prescription Drug Plan

Solution

Our clinical team dug in, aligning the group with a value-based formulary that favors low-cost generic alternatives over high-cost brand name drugs while still maintaining high quality patient. Through strong contract management with pharmacies and manufacturers along with utilization management procedures, we were able to provide this group even greater savings.

Our implemented cost containment strategies, including appropriate utilization management, helped this group positively achieve balanced financial and clinical goals even with this new, unexpected high-cost claimant.

By leveraging PBD’s unique relationship with our sister company and specialty pharmacy provider Reliance Rx, we were able to manage targeted disease states and cost through innovative programs like the Specialty Copay Assistance Program (SCAP) and disease-specific clinical programs. Reliance Rx also provided comprehensive monitoring and outreach programs to help deliver improved specialty drug outcomes for this group.

Results

Even when this unforeseen high-cost claimant – whose claim spend totaled 14.3% of the group’s overall plan spend – was added to the plan, PBD’s thorough and targeted approach to cost containment helped this group realize an additional 35% in savings to their overall plan spend compared to the year prior. While the member count of the group remained the same from the previous year, PBD also significantly reduced the group’s per member per month (PMPM) costs from $70.50 to $44.17.

Through proactive efforts, strong formulary management practices and integration with our specialty pharmacy partner, this group benefited from PBD’s unwavering commitment to help our clients achieve positive clinical outcomes while maximizing value at the lowest net cost even when unexpected things happen.

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

Learn More

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.