Delivering Impressive Results Through a Custom Network Strategy

Working to Manage Costs

Prescription affordability is a top issue in health care, compelling plan sponsors to find better ways to manage costs while preserving care quality for members. Golden Entertainment, a premier gaming corporation, is no exception. After experiencing continued increases in pharmacy costs, for both the plan and its members, the plan steered away from the traditional pharmacy benefit management model and sought a pass-through partner that could help them reduce expenses and “reinvent their pharmacy benefits”. It was this decision that led them to collaborate with Navitus and achieve double-digit plan and member savings in just four months.

Developing a Customized Network Solution

By switching pharmacy benefit managers (PBMs), Golden Entertainment was able to get a clear view into their pharmacy cost and savings opportunities. Moving the benefit management in the right direction, the two teams worked to identify possible cost containment strategies that could deliver real savings and improve member health.

Working collaboratively, Golden Entertainment and Navitus identified pharmacies to engage in a tiered pharmacy network approach. The network was designed to offer deep discounts for the plan and its members, while maintaining a wide selection of pharmacies to promote member choice and convenience. Using a tiered plan, members were incented to choose a pharmacy within the limited network at a lower copay, with the option to select any pharmacy within the national wrap network at a higher copay.

Achieving Double-Digit Plan and Member Savings

Just four months after implementation, the network strategy generated a significant cost reduction of 33.5%. That’s a savings of one third of plan costs when comparing it to the same time from the prior year to Navitus. In addition, plan-paid per member per month (PMPM) costs were reduced by 29.4%. One full year into the program, Golden Entertainment experienced substantial savings of more than $620,000 in total costs ($500,000 in plan savings and $120,000 in member savings).

Member benefited from the network strategy, too. With a wide pharmacy selection and low copay option, members embraced the limited pharmacy network. As a result, they experienced a 24$ member cost reduction.

By reexamining its PBM, Golden Entertainment and its members are enjoying the full benefit of these savings with Navitus’ transformative pass-through approach. The model ensures all network reimbursement improvements, including all upside performance, are immediately passed through to Golden Entertainment for the full life of the contract. With Navitus, Golden Entertainment can spend less time worrying about its pharmacy benefits and more time focusing on creating world-class experiences.

Getting Started

Are you interested in learning how a truly transparent, pass-through model, and custom network solutions, could lower your plan spend. Contact us at [email protected] to learn more.