A large health plan client of PillarRx was looking to save money for their overall pharmacy benefits program including commercial, Medicare Part D and ASO lines of business. They asked PillarRx if a focused RFP/Market Check effort could be completed to evaluate selective PBMs and determine if better services and pricing were available in the marketplace.
PillarRx completed a custom RFP process for this client that included a full financial analysis for all lines of business and a focused 25-question qualitative questionnaire. This process needed to be completed quickly in order to try to meet a year-end deadline that was less than six months away. PillarRx assisted the client with developing a custom questionnaire to focus on five main areas of interest as part of the qualitative component of the RFP process. The PillarRx team completed a full financial analysis for all lines of business and evaluated the responses to the questionnaire within the time frames promised to meet the client’s deadline.
The results of the RFP process provided an opportunity for the health plan to renegotiate 8.25 percentage points better overall on their commercial contract and 11.6 percentage points better overall on their Medicare Part D contract. In addition, the PBM administers rebates for the Medicare Part D program and PillarRx assisted the health plan with gaining almost $260 more on average per brand claim than what the health plan was receiving previously. Lastly, PillarRx assisted the client with renegotiating the terms of their contract and was instrumental in revising and including additional language to further protect the client from unexpected shifts in guarantees, clarify calculation methodologies and right-size how guarantees were calculated based on ambiguous caveat language.