Client Profile

Challenge

Organizations across the nation struggle with prescription drug benefits’ ever-changing and ever-increasing cost to employers’ health plans. These costs currently make up approximately 15 to 20 percent of an employer’s health plan expenses. Faced with the need to decrease its health plan spend by millions of dollars to stay financially afloat, a 2,000-employee organization in Tennessee engaged CBIZ Employee Services Organization and its National Pharmacy Consulting Practice to analyze if they were overspending on its pharmacy benefit plan and to quickly identify sustainable, cost-saving solutions.

Solution

After reviewing the organization’s pharmacy plan, CBIZ consultants identified the organization’s pharmacy pricing was uncompetitive and their utilization was not managed appropriately per the plan’s benefit design. With these issues in mind, the local CBIZ ESO office and CBIZ National Pharmacy Consulting practice implemented the following strategies: marketed the PBM component of the benefit; implemented a new PBM on a carve-out basis for 2016; reviewed pharmacy set-up documentation from scratch to ensure the benefit was programmed correctly; included plan design changes to promote member cost awareness and consumerism; increased claims monitoring to track savings and create more programs as needed.