Recently, PillarRx was awarded a pharmacy consulting project for a large health plan. The Plan recently saw a spike in overall pharmacy spend. Over the same timeframe, there was an increase in reported member complaints. The PillarRx team reviewed past utilization trends, service level agreements, and overall pharmacy services. PillarRx reported actional findings to the plan that the current PBM contract was outdated and did not adequately include necessary member programs.
PillarRx worked with the client’s stakeholders to develop, administer, and solicit a PBM RFP for five potential vendors. Questions focused on financial guarantees and services offered to meet this client’s unique needs. Following the selection of a new PBM, PillarRx was instrumental on providing contract negotiations and oversaw the implementation process.
The new contract provided the client with additional cost-savings opportunities, cost-containment strategies, and improved service level agreements. Specifically, this client realized a decrease in PMPM of $17.98 and administrative fees of $84,000. Negotiating market-correct performance guarantees allowed for better staffing levels and an increase in member satisfaction. There was an excess of $400,000 now available to the plan for additional pharmacy programs to be implemented to this growing health plan!