Taking Greater Control of Rx Costs: A Case Study

Tired of efforts to lower pharmacy costs having little impact on the bottom line? Plan sponsors are growing frustrated as the industry continues to find ways to add cost without adding value.

According to a recent study, 85% of employers said that pharmacy pricing was their predominant concern going into 2020.¹ In the U.S. healthcare system, the estimated cost of waste ranges from $760 billion to $935 billion, or about 25% of total healthcare spending, according to a recent report in JAMA.² Even one high-cost drug can consume a significant portion of a health care budget, making it increasingly important for plan sponsors to find more cost-effective drug solutions to reduce waste and unnecessary expenses.

It’s time to start taking control of pharmacy benefit costs. Find out how one plan went from year-over-year double-digit trend increases to achieving a less than 3% average increase over six years.

Navigating Complex Pharmacy Benefits

Self-Insured Schools of California (SISC) was diligent about keeping benefit costs affordable and stable by pooling the resources of its over 400 member school districts in 43 counties across California. Despite its actions to lower pharmacy costs, SISC grew tired of its efforts having little impact. SISC knew it needed a new perspective with more transparency and clarity to enhance its pharmacy benefit strategy.

Uncovering Significant Savings Opportunities

With the help of its consultant, SISC decided to partner with Navitus. Instead of increasing its spend by covering more expensive drugs to get higher rebates, SISC wanted to establish a high-performance formulary with clinically effective alternatives at the lowest net cost.

Reducing Costs and Maintaining Member Access to Care

By making a few changes, SISC was able to eliminate waste and lower costs while ensuring members received the most clinically appropriate, safe and cost-effective medications. As a result, SISC has maintained strong benefits that allow members to continue to have affordable access to the therapies they need.

Want to see the results?

Download the full case study to find out how SISC removed over 600 unnecessary drugs from the formulary with minimal member impact.

Despite its actions to lower pharmacy costs, SISC grew tired of its efforts having little impact on the bottom line. It was time for a new perspective with more transparency and clarity to enhance its pharmacy benefit strategy.

With the help of its consultant, SISC decided to partner with Navitus to establish a high-performance formulary with clinically effective alternatives at the lowest net cost.

SISC saw a significant decrease in total net cost PMPM in the first year, and maintained nearly flat costs in each succeeding year.

Download the FULL case study to learn more

Waddill, K. Employers Focus on High-Cost Claims, Drug Spending into 2020. Health Payer Intelligence. https://healthpayerintelligence.com/news/employers-focus-on-high-cost-claims-drug-spending-into-2020. Published August 15, 2019. Accessed February 12, 2020.

Elfin, D. Waste Gobbles up 25% of US Healthcare Spending, JAMA Study Finds. Healthcare Dive. https://www.healthcaredive.com/news/waste-gobbles-up-25-of-us-healthcare-spending-jama-study-finds/564433/. Published October 7, 2019. Accessed February 12, 2020.