Demanding Greater Transparency and Better Performance: A Case Study

Looking for a PBM that delivers savings and aligns with your goals? You’re not alone.

Finding a prescription benefit manager (PBM) that offers savings, flexibility and alignment to the plan sponsor’s goals can be a challenge. With the availability of varying models, ranging from traditional to pass-through, shopping for the right PBM comes down to understanding the contract details.

A National Pharmaceutical Council study¹ highlighted employers concerns regarding PBM transparency and complexity, including:

• 63% believe that PBMs lack transparency in how they make money
• 58% agreed that contracts are overly complicated and often harbor clauses that benefit the PBM at the expense of the employer or patient
• 33% stated that their PBMs are strongly aligned to their goals

Employers deserve better. Find out how one plan achieved double-digit savings by choosing to partner with a transparent pass-through PBM.

Finding the right PBM partner

San Diego Electrical Health & Welfare Trust (the Trust) experienced this situation first-hand. In working through a contract renewal with its former PBM, the Trust and its consultant uncovered questionable contract details. Through further evaluation, the Trust realized its PBM lacked transparency and flexibility, leaving them to wonder if they were receiving all the available savings.

Looking at PBMs through a new lens, the Trust went out to bid, carefully scrutinizing PBMs based on their models and contract language. Their goal: complete transparency and pass through to reduce costs.

Collaborating on goals

Understanding the Trust’s desire to be fully engaged in its pharmacy benefit, offer quality programs, and deliver costs saving measures that reduce expenses and improve member well-being, Navitus built a customized program to meet the Trust’s needs.

The process started with a clear and exact contract that aligned to the Trust’s goals.

In keeping with its principle of full transparency, Navitus offered 360-degree operational and financial visibility for greater clarity into cost and savings opportunities.

Then Navitus, through its robust reporting, offered the Trust unrestricted insight into its data to provide guidance in the right direction and unlimited flexibility to improve benefit performance.

Delivering results

The collaboration between the Trust and Navitus resulted in an impressive first year. With Navitus’ unique pass-through model, 100% of all discounts and rebates received were passed directly back to the Trust.

In working through a contract renewal with its former PBM, San Diego Electrical Health & Welfare Trust (the Trust) and its consultant uncovered questionable contract details. Through further evaluation, the Trust realized its PBM lacked transparency and flexibility, leaving them to wonder if they were receiving all the available savings.

Looking at PBMs through a new lens, the Trust went out to bid, carefully scrutinizing PBMs based on their models and contract language. Their goal: complete transparency and pass through to reduce costs.

Getting complete transparency and pass through pharmacy benefits management resulted in a 21% decrease in total net cost per member per month (PMPM) in the first year.

Download the FULL case study to learn more.

How did they do it?

Using Navitus’ unique pass-through PBM model guaranteed that 100% of all discounts and rebates received were passed directly back to the Trust.

Toward Better Value: Employer Perspectives on What’s Wrong with Prescription Benefit Management and How to Fix it, National Pharmaceutical Council, 2017.