PBM Carve-Out Plan:

Saving Nearly $3 Million in a Year

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$644K

Savings due to Improved Discounts

$2.2 MILLION

Unlocked hidden and improved rebate value

$2.9 MILLION

Client’s total savings

The Situation

CITY GOVERNMENT

SOUTHEAST REGION

8,648 EMPLOYEES

One of our brokers had a city government client in the Southeast 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.

The 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 year savings of $2,878,266.

Pricing

FAVORABLE DISCOUNTS, TERMS, AND CONDITIONS

Stability

DECREASE RENEWAL VOLATILITY

Control

ALLOWS FOR STRATEGIC PLANNING & FINANCING

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 & Claims Reporting

Dedicated Account Management Team & Clinicians

PROCESS

  • Crumdale’s experienced pharmacy benefit experts talked to the broker and client about the advantages of carving-out to achieve better transparency into their prescription drug benefits, plan costs, and contract details.
  • Our team facilitated the transition through a comprehensive implementation plan with limited disruption to their members while still offering recommendations to benefit the client and provide additional saving opportunities.
  • We maintained a strong and trusted relationship with the broker and the client by addressing all concerns and continuing as a consultative, trusted advocate through the life of the contract.

RESULTS

By carving out the client’s pharmacy benefits with transparency and cost savings, Crumdale delivered the client $2.9 Million in savings in a year.

  • The client saved a total of $2,878,266 in a year through discounts, dispensing fees, rebates, utilization management, and contract compliance recovery savings.
  • $644,152 Incremental Discount Savings
  • $37,385 Dispensing Fee Savings
  • $2,196,729 Incremental Rebate Savings

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.

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INSURANCE ISN’T NEW, BUT THE WAY WE TAILOR IT TO MEET YOUR NEEDS IS.

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