Delivering Double-Digit Pharmacy Savings: A Case Study

Posted by Navitus Health Solutions on Apr 30, 2020 9:04:07 AM

With rising growth projections on top of already high costs, it’s no wonder that plan sponsors are looking for ways to reduce expenses and improve member health.

The National Business Group on Health (NBGH) recently conducted a study that included responses from 147 large employers, who represent over 15.6 million employees and their dependents. Of these, 54 percent were Fortune 500 companies and 39 of them were Fortune 100.1 The survey found that “for 85 percent of employers, pharmacy pricing was their predominant concern going into 2020.”1

If you’re like these employers, you may be seeking an alternative solution to help you take the unnecessary costs out of pharmacy benefits and make prescriptions more affordable for you and your members. Find out how one electric utility cooperative was able to achieve double-digit plan and member savings in the first-year by switching to a transformative pass-through model.

IMPROVING EFFICIENCIES WITH A MEDICARE WRAP

Prior to Navitus, Kentucky Rural Electric Cooperative (KREC) populations had two separate pharmacy networks and benefit plans, causing confusion and disruption. Retirees used two different PBM benefit cards to pay for their prescriptions and pharmacies had to adjudicate each claim twice, once for each plan. Working closely with KREC, Navitus designed a wrap solution that applied the same national network to both populations and provided for single-point claim adjudication and plan administration.

REDUCING COSTS THROUGH FORMULARY MANAGEMENT

In addition to a self-funded Medicare wrap, a second cost reduction opportunity was identified in KREC’s formulary management. Instead of using a common formulary that prioritized rebates above all else, KREC chose to switch to a well-managed formulary that prioritized the lowest-net cost without compromising access to clinically effective medications. Then they supported the formulary with a comprehensive suite of utilization management tools, including prior authorization, step therapy and quantity limits.

REALIZING PLAN AND MEMBER SAVINGS

The collaboration between KREC and Navitus yielded impressive first-year results, including a 29% decrease in plan costs. These savings benefited not only the plan, but its members, too.

Want to see the results?
Learn more about KREC’s journey to finding a PBM partner that was able to tailor its program to the specific needs of both the plan and its members, while delivering impressive real results. 

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  1. Waddill, K. Employers Focus on High-Cost Claims, Drug Spending into 2020. Health Payer Intelligence. https://healthpayerintelligence.com/news/employers-focus-on-high-cost-claims-drug-spending-into-2020. Published August 15, 2019. Accessed February 12, 2020.

Topics: Case Studies

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