As a team of benefits strategists, we work hard every day to make sure we’re exceeding client expectations and providing the most innovative and value-generating plan designs and advisory services.
Client Realizes Nearly $3M in Rx Savings in One Year
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 $11.8M 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. 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.
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.
More Case Studies
- September 20, 2022
Prior to Apex becoming the strategic advisor, this client also had a near-site clinic available to all members on the medical plan. After a thorough review of clinic data, our team found that the cost per visit exceeded $225 due …
- August 10, 2022
Working closely with the insurance company’s reinsurance and pharmacy teams, the Kinetiq Health team came up with a solution to purchase the treatment directly from the manufacturer at actual cost while the hospital continued administering the dependent’s infusion therapy each …
- July 19, 2022
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.