Evergreen Rx's Aggressive Proposal Challenged our Client's Thinking on the PBM Industry

Case Study

Situation:

A leading health plan client was experiencing a 15% drug trend under a long term contract with a PBM that auto renewed for five years. Although the health plan’s preference was to continue their relationship with their current PBM for fear of having to implement a new vendor with their members, and despite the fact that their current PBM had offered new rates, the health plan nevertheless decided to go to the markets through an RFP process.

Strategy:

• Reviewed existing PBM contract
  
• Developed the RFP process and take it to market
  
• Negotiated bid with existing PBM
  
• Presented alternative PBM options
  
• Developed detailed analysis of each bid showing how savings would be generated
  
• Spelled out and compare services made available in each proposal
  
• Provided objective analysis making final recommendations on proposal best serving serves the interest of the client

Results:

• Using Evergreen Rx’s leverage, the health plan received aggressive proposals that challenged the health plans thinking on the PBM industry by:
  
• Sharpened the incumbent bid by over $3 per claim.
  
• Presented alternative PBM options that saved in excess of $5 per claim.
  
• Provided detailed analysis making it clear switching vendors was in the client’s best interest
  
• Assisted in contract negotiation and on-time implementation
  
• Provided leverage to ensure the health plan has the clearance to manipulate formulary.

For a health plan with 100,000 members, the savings for a similar program would amount to $5.4 million annually.