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Pharmacy savings2

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Pharmacy savings2

  1. 1. CASE STUDY PHARMACY SAVINGS THROUGH EXPERT NEGOITATIONS THE CLIENT Industry: Solid Waste Number of Employees: 2,000 THE CHALLENGE A North Carolina based employer approached Marsh & McLennan Agency (MMA) with concerns around rising medical and pharmacy claim costs and their potential exposure to penalties from the 2018 Cadillac Tax. To identify the contributing factors, our team of benefit specialists conducted a thorough examination of the employers claim cost drivers and completed a benefit plan benchmark analysis. Our evaluation determined the employer was offering significantly richer benefits than comparable employers in their industry and MMA also uncovered a much higher than expected per employee per month pharmacy spend.
  2. 2. CASE STUDY PHARMACY SAVINGS THROUGH EXPERT NEGOITATIONS THE SOLUTION The MMA team concluded that one significant way to reduce claim costs and minimize the employer's exposure to the Cadillac Tax was to lower their pharmacy spend. To do this, MMA engaged the Rx Solutions team to complete an evaluation of the employer's current pharmacy benefit manager (PBM) and contract. After their evaluation, MMA identified two significant ways to improve and save cost within the current contract: 1) improving the price paid per drug 2) rebate cost sharing In addition, the employer leveraged our pharmacy experts to further negotiate their contract with the current PBM.
  3. 3. CASE STUDY PHARMACY SAVINGS THROUGH EXPERT NEGOITATIONS THE RESULT After successful negotiations with the current PBM, the client improved their unit pricing and had their contract language revised to prevent the PBM from reclassifying drugs to higher cost categories. The PBM also increased the employer's rebate sharing significantly. In addition, the PBM agreed to an annual utilization review to ensure the revised contract language was being adjudicated properly. MMA's involvement resulted in $250,000 (or 8% of the employer's Rx spend) in annual savings without a change in PBM, plan design, pharmacy network or clinical programs and minimized Cadillac Tax exposure.