Problem
For employer groups striving to achieve maximum cost savings while improving patient outcomes, it is critical that they partner with a transparent PBM. Transparency by a PBM into the many contributing factors that drive prescription drug costs allows plans to make more informed decisions, resulting in opportunities for savings and increased efficiencies for their specific needs.
When an 800-life municipality approached Pharmacy Benefit Dimensions (PBD) because their incumbent PBM did not provide full transparency into their plan’s pharmacy utilization data or prescription drug cost, our clinical team dug in for solutions.
Client Overview
Industry: Municipality
Group Size: 800
Plan Type: Medicare Part D, Employer Group Waiver Plan (EGWP) Prescription Drug Plan (PDP)
Solution
Even with limited data, PBD’s clinical team performed a full review by applying our vast PBM industry experience and clinical knowledge to fill in the gaps to help better understand the plan’s current drug formulary and identify inefficiencies with their current PBM. Due to the lack of transparency their current PBM provided, it was evident that the municipality’s leadership was limited in their ability to identify overall healthcare cost savings opportunities.
PBD’s analysis identified how our relationships with drug manufacturers could benefit this group. Since PBD contracts directly with drug manufacturers, we are in a unique position to leverage our overall population, experience, and clinical acumen to secure the best rates possible.
For this municipality, PBD identified several savings opportunities compared to their current PBM.
Results
By simply applying PBD’s lower negotiated rates to the plan’s current formulary, this municipality achieved a 18% cost savings with PBD compared to their previous PBM spend.
Our direct contracts and relationships with drug manufacturers can lead to a cost savings of at least 8-to-10% for employer groups without the need to make a formulary change.
In addition, we can provide contractual and formulary flexibility other PBMs cannot, or will not, offer. For small-to-mid size plans, larger PBMs will not allow custom formularies or contract with pharmaceutical manufacturers for just one plan. Smaller, white-label PBMs operating under the management of the largest PBMs do not have the flexibility to change their contracts, limiting formulary options. This is where PBD’s nimbleness and ability to customize for you matters.
As pharmacy cost continue to rise, it will be critical to partner with a transparent PBM that can leverage its relationships with drug manufacturers to provide contract flexibility resulting in clearly defined and customized solutions to meet their specific plan needs.