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.
Rebates and PBM Contract Review Net 55% in Rx Cost Savings
Client
A mid-sized company with diverse holdings in the food and entertainment sector with about 400 employees
Challenge
The employer was content with the pace at which overall benefit costs were rising over the years, but wanted to tackle the disproportionately high rise of pharmacy benefit costs. The client sought ideas to reduce the costs while maintaining the overall quality of benefits enjoyed by its employees. The client was in a “carve-in” PBM through a national carrier and its annual Rx costs were $1,055,385 after discounts.
The client sought ideas to reduce the costs while maintaining the overall quality of benefits enjoyed by its employees. The client was in a “carve-in” PBM through a national carrier and its annual Rx costs were $1,055,385 after discounts.
Solution
The Apex team identified hidden sources of revenue the PBM embedded in the client’s contract. After reviewing the language of the PBM that determined the contract structure and pricing, the client was able to find savings without changing any benefits to its employees.
Results
After discounts, rebates and fees, the client enjoyed annual savings of $405,311 from its Rx spend. Apex also uncovered additional savings through clinical, utilization and specialty drugs of another $117,874. That meant more than $580k in savings. Those savings totaled 55% of the costs from the prior year, a drastic reduction in spend.
Case Study
Download a printable version of this case study
More Case Studies
- March 28, 2023
Peer Review Reduces PEPM Cost by 42% for Global Consultant
A holistic peer review identifies significant savings and opportunities to reduce administrative burden for a small HR team serving 500 employees around the globe. Basic broker services were replaced with a strategic partnership that created deep, sustainable cost savings.
- September 20, 2022
Large School System Builds $14.3M Reserve in Five Years
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
$2.4M in Rx Cost Savings Identified for Financial Sector Client
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 …
