We use cookies to provide services and improve browsing experience on this website. See our Cookie Policy for more information. By continuing to browse this website, you agree to the automatic use of cookies. We’re sorry we are currently unable to provide real delicious cookies to you and your friends.
Client
A large Indianapolis-based employer with 16,000 covered lives across the U.S.
Challenge
The client had been experiencing steadily increasing costs of Rx claims with most
recent annualized pharmacy claims of $11.8M for its plan members.
Solution
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. Apex 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.
Results
The client saved $2.7M net of Apex fees 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.
Case Study
Download a printable version of this case study
Download Case StudyMore Case Studies
- August 31, 2023
Second Opinion Program Provides Support and Answers for Plan Members
A family employed by an Apex client was seeking answers and resources as they navigated their child’s complex health challenges. Apex’s Second Opinion Program connected them with world-renowned experts and vital local support.
- July 27, 2023
County Creates Sustained Savings Through Switch from Fully Funded to RBR
A county government with 100 employees partnered with Apex to implement reference-based reimbursement. Over the next 6 years, they experienced sustained savings on both health care spend and PEPM costs.
- June 15, 2023
County Saves Millions with RBR and Changes to Pharmacy Benefit
A county government with over 450 employees partnered with Apex to implement reference-based reimbursement and saved millions over 7 years, decreasing their PEPM costs in the process.