Please enjoy reading these insights from Confidio’s pharmacy benefit consulting team to better anticipate and navigate the historic disruptions ahead. We look forward to receiving your comments and feedback.
The client was unable to obtain a pharmacy contract from its health plan and unable to validate pricing or rebate value. Through advanced analysis, working in close partnership with the company’s benefits advisor, we drove savings of more than $1 million.
The client had five individual hospitals, each with its own PBM contract. Our Strategic Sourcing solution consolidated five contracts into one and leveraged internal dispensing capabilities, which resulted in a cost savings of 21%.
Without any internal resources or insider PBM expertise, the client was unable to integrate detailed contract language or raw claims data. Quarterly Performance Analytics Contract Compliance Analytics identified a nuanced contractual commitment that was not accurately coded in the PBM’s system, resulting in a $5 million refund to the plan.
This carve-out Insurance carrier’s savings through PPS are in excess of $1 million over the three-year contract term and the pharmacy plan came in 19% below budget. Account management and vendor oversight, along with PPS’s semi-annual audit reporting, were the keys to this client’s success story.