Northeast Taft-Hartley client retained PBIRx services in 2010 and directed that there be no change in members’ flat dollar copayment and that plan design changes have no member disruption.
On a continuum, PBIRx developed a multi-phase strategy to introduce various third-party programs and plan design cost savings programs with minimal to no member disruption.
The following phased-in strategy steps included:
- Renegotiated PBM contract every two years increasing rebates and discounts.
- Utilized proprietary algorithms to identify clinical programs, number of members affected, and estimated savings so that the union could make an educated decision on which programs to implement.
- Performed annual PBM audits, negotiated with PBM, and facilitated recoveries.
- Analyzed managed formularies for increased rebates, lower discounts, and member disruption.
- Presented and analyzed value of removing major chain from network, resulting in deeper discounts, no member disruption.
- Vetted and presented savings analysis for zero-member copay programs including a PBM manufacturer coupon program, international program, and specialty drug alternate funding program. PBIRx was very involved in each implementation to ensure positive member experience.