PBM Carve-Out Plan:

Saving Over $2 Million in 2 Years

The Situation

healthcare client      65 Locations      45k Employees

One of our brokers had a healthcare client in the Northeast who felt that they lacked a clear understanding of their prescription plan costs, benefits, and rebates.

They had concerns about increased drug spend and didn’t feel they were getting the service or attention they deserved. The client struggled with a lack of reporting options and a lack of visibility into their prescription drug benefits and contract.

Due to the lack of transparency into their pharmacy benefits and insufficient opportunities for cost savings through the incumbent pharmacy carrier, the client worked with their broker to switch to Crumdale Partners for a custom PBM carve-out plan.

Goals

Client:

Work with their broker to access a custom PBM carve-out plan with Crumdale’s strategic cost-saving solutions and contract transparency.

Broker:

Work with Crumdale to carve out a custom PBM plan for their client with contract validation and support for ongoing cost savings.

$2.8 Million+

Client’s total two-year savings through our PBM carve-out solution

$1.3 Million+

Total utilization management savings

$700 k+

Incremental rebate savings

The Results

Immediate Results

With Crumdale’s expert pharmacy benefits consulting, PBM contract transparency and validation, and custom carve-out, the client was able to access market-leading discounts and rebates for a two-year savings of $2,816,397.

How We Did It

The client had many Issues with their previous Pharmacy Benefits carrier, which crumdale solved by carving out a custom plan with the following:

  • Cost Reduction Programs
  • Automated RFP Process
  • Lifetime Contract Validation Support
  • Market-Leading Discounts & Rebates
  • Advanced Strategic Insight
  • Dedicated Account Management Team

by carving out the client’s pharmacy benefits with transparency and cost savings, crumdale delivered the client $2.8 Million in savings in 2 years.

Process

  • Crumdale’s experienced account management team talked to the broker and client about the advantages of carving-out to achieve better transparency into their prescription drug benefits, plans costs, and contract details.
  • Our team facilitated the implementation for the client with little disruption to their members by offering recommendations to benefit the client and provide additional savings opportunities.
  • We continued to build a strong and trusted relationship with the client by addressing all concerns and remaining as a trusted advocate.

Results

  • The client saved a total of $2,816,397 over a two-year period through discounts, dispensing fees, rebates, utilization management and contract compliance recovery savings.
  • $589,474 Discount & Dispensing Fee Savings
  • $749,801 Incremental Rebate Savings
  • $1,319,283 Utilization Management Savings
  • $157,839 Contract Compliance Recovery

Independently & actively ensuring savings

Crumdale Partners independently validates all contractual pricing guarantees and holds PBMs accountable for any discrepancies. This allows clients to ensure their contract is performing as expected and sustains savings. Twice per year, we analyze claims and apply your PBM’s contractual financial guarantee methodologies to ensure discounts.