Delivering Impressive Results Through a Custom Network: A Case Study

Posted by Navitus Health Solutions on Mar 13, 2020 7:00:00 AM

Discover how one employer achieved double-digit savings for both the plan and their members. 

Prescription affordability is a top issue in health care, compelling plan sponsors to find better ways to manage costs while preserving care quality for members. 

Implementing a narrow retail network is just one of many strategies plan sponsors often choose to lower costs. But equally as important as maximizing savings is minimizing member disruption. Working with their Pharmacy Benefit Managers (PBMs) to accomplish both, plan sponsors are beginning to adopt this cost savings mechanism more and more. In fact, in 2019 Navitus saw a 25% increase in the number of clients using a narrow network.1

To create a narrow network, PBMs contract with select pharmacies to secure lower rates. As members start using the pharmacies, the plan generates savings. All PBMs offer a network solution, however with a pass through vs. a traditional model you can expect to maximize savings since all improvements are immediately passed back to the client. Using a narrow network strategy with a pass through PBM will typically save you between 3-5% off retail drug spend. Some savings can be in the double-digits, as was the case with this client.

working to manage costs

Golden Entertainment, Inc., a premier gaming corporation, continued to experience increases in pharmacy costs for both the plan and its members. The plan steered away from the traditional PBM model and sought a pass-through partner that could help them reduce expenses and “reinvent their pharmacy benefits.”

DEVELOPING A CUSTOMIZED NETWORK SOLUTION

By reexamining its PBM, Golden Entertainment and its members are enjoying the full benefit of these savings with Navitus’ transformative pass-through approach. The model ensures all network reimbursement improvements, including all upside performance, are immediately passed through to Golden Entertainment for the full life of the contract.

Working collaboratively, Golden Entertainment and Navitus identified pharmacies to engage in a limited, tiered pharmacy network approach. The network was designed to offer deep discounts and generate savings for the plan and its members, while maintaining a wide selection of pharmacies to promote member choice and convenience.

ACHIEVING DOUBLE-DIGIT SAVINGS
Just four months after implementation, the network strategy generated a significant cost reduction of 33.5%. That’s a savings of one third of plan costs when comparing it to the same timeframe the year prior to Navitus.

Want to see more results?
Download the full case study to find how the double-digit savings continued for both the plan and its members during their first year!

Specialty Pharmacy Solutions_March 2020 Final.pdf

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  1. Navitus Internal Data 

Topics: Case Studies

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