Achieving Cost Savings and Regulatory Compliance: A Case Study

Written by Navitus Health Solutions | 5/14/20 1:00 PM

A recent study found that many plan sponsors aren’t taking full advantage of all the pharmacy benefit management (PBM) tools that are available to them, including rebate management, drug utilization programs and formulary management tools, to name a few.

The study estimates that if plan sponsors actually used the full range of PBM tools available, they could save more than 30% on drug benefit costs, compared to organizations that opt out.¹ In fact, it’s estimated that consistent PBM tool use could reduce prescription drug costs by $1 trillion over the next decade in the U.S.¹

Find out how one health plan decided to take action, seek out a new PBM partner and maximize PBM tool use to successfully reach its goals.

Establishing Strategies for Success

Colorado Access, a nonprofit health plan with more than 500,000 members, wanted to rein in its pharmacy costs and ensure regulatory compliance for its Medicare line of business. After deciding to partner with Navitus as its PBM, the two worked to convert barriers to savings and compliance into opportunities. Navitus created a strategic plan to help Colorado Access to maximize PBM tools and reach its goals, which focused on a few key areas.

Improving Formulary Performance
A high-performance formulary was established, to strike a balance between offering access to high-quality, clinically effective medications and delivering the lowest net cost.

Managing Rebates Effectively
By combining creative rebate management with agile benefit design changes, Colorado Access was able to drastically reduce its drug costs.

Achieving Compliance
With the help of Navitus’ regulatory experience and in-house tracking system, quality assurance and reconciliation processes, Colorado Access realized substantial improvements in Medicare compliance, especially in Prescription Drug Event (PDE) reconciliation, which resulted in significant savings.

Achieving drug trend decreases and million-dollar SAVINGS

Through these efforts, Colorado Access achieved a negative drug trend in three of the first four years with Navitus, which was a dramatic improvement over the increasing drug trend it experienced with its previous PBM.

Want to see the results?
Download the full case study to find out how Colorado Access achieved a more than 50% decrease in drug trend in the first year!

King, R. PBM industry report claims greater use of tools can generate $1T in savings over the next decade. Fierce Healthcare. https://www.fiercehealthcare.com/payer/pbm-industry-report-claims-greater-use-tools-can-generate-1t-savings-over-next-decade. Published February 19, 2020. Accessed May 12, 2020.

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