Reducing Rx Costs While Maintaining Benefit Quality

Situation

This client was a mid-sized employer with diverse holdings. Their overall benefit costs were rising at an appropriate pace, however, the cost of Rx was disproportionately high. The client sought ideas to reduce cost while maintaining the quality of benefits for employees. They were using a “carve-in” PBM through a national carrier, and their annual Rx costs were $1.1M after discounts.

Solution

The ExudeRx team identified hidden sources of revenue the PBM embedded in the client’s contract. With a unique approach to contract structure and pricing, our team was able to lead the client to savings without a benefit change.

Results

The total identified potential savings was 49%. Specifically:

• Annual savings (discounts, rebates, fees): $398,902 (38%)
• Additional savings (clinical, utilization and speciality): $119,864 (11%)