Winning the Bid:

How Boutique Beat National

$1.3 MILLION +

Saved more than $1.3 million vs renewal

2%

Showed a 2% increase vs current rates

4 MEMBERS

Pre-identified 4 members for alternative med & Rx savings programs

The Situation

One of our broker partners runs a boutique brokerage firm. One of their long-standing clients decided to do their due diligence and invite in a large national brokerage house to run an analysis on market opportunities for renewal.

The employer group is a specialty pharmacy consulting company in the Northeast that was offering a fully insured medical and prescription drug program since 2004 with Blue Cross.

In the midst of a worldwide pandemic, the employer group received a 40% renewal increase from their insurance carrier.

The employer group questioned the merits of such an increase and wanted to understand their claims data and the details of the contracts governing their plan – particularly the pharmacy benefits contracts.

Minimal claims information was made available and the contracts were completely unavailable.

Goals

CLIENT:

Save money and gain transparency and flexibility in the plan.

BROKER:

Win the bid. Implement both a short-term and long-term solution/strategy.

Before & After

Before After
Program Structure Fully Insured (12 equal premium payments) Self-Funded
Third-Party Administrator (TPA) Blue Cross Independent TPA
Network Blue Cross National Network
Pharmacy Benefit Manager (PBM) Blue Cross Transparent PBM Contract
Medical Stop Loss Blue Cross Resolute Underwriting Strategies
Claim Review & Monitoring None Franklin Health
Pharmacy Oversight None Franklin Health
Data Analytics None Franklin Health
Plan Document Review None Franklin Health
ERISA Guidance & support None Franklin Health
Compliance Review None Franklin Health
Patient Advocacy / Engagement None Franklin Health
Alternative Funding Programs (RX) None Franklin Health

The Results

Incumbent (2020) Incumbent Renewal (2021) Incumbent Renewal (2021)
# of Employees 421 421 421
Max Spend $3,523,773.60 $4,941,438.36 $3,624,073.97
Spend, PEPY $8,370.00 $11,737.38 $8,608.24
Expected Spend $3,523,773.60 $4,941,438.36 $3,002,914.51
Differential @ Max + 40% + 2%
Differential @ Exp + 40% -14%

The group saved $1.3 Million @ max vs renewal.

The group received a 2% renewal @ max and a 14% decrease @ expected.

Pricing

FAVORABLE DISCOUNTS, TERMS, AND CONDITIONS

Stability

DECREASED RENEWAL VOLATILITY

Control

ALLOWS FOR STRATEGIC PLANNING & FINANCING

How We Did It

THE CLIENT HAD MANY ISSUES WITH THEIR PRIOR FULLY INSURED BLUE CROSS PLAN.

Lack of alignment between carrier and
employer

Zero transparency on medical and pharmacy claims

No claims management

Carrier retained all PBM rebates

No clinical integration

Little broker or client control