Pass-Through PBM Partnership Value

Prior to implementing the Navitus Key solution (formerly EpiphanyRx), a mid-size employer in the food industry was grappling with substantial year-over-year increases in per member per month (PMPM) pharmacy costs. The organization struggles to understand their plan’s complexities, particularly around costs and rebates. This confusion made managing expenses difficult.

Optimizing Pharmacy Spend and Enhancing Transparency

To address these issues, the organization’s advisor evaluated multiple progressive pharmacy benefit manager (PBM) offerings. After careful analysis, they selected us as the ideal partner to optimize the pharmacy benefit plan. We provided a tailored approach that focused on enhancing transparency, improving rebates and implementing effective clinical management strategies.

Partnering with Navitus led to impressive outcomes, including an overall year-over-year improvement in pharmacy plan spend. Notable improvements included a 54% increase in drug rebates, a strong copay assistance program providing $1.4 million in savings to plan members, and a 51% prior authorization approval rate.

After making the switch to Navitus, the client experienced a 47% reduction in net plan cost PMPM ($67.10 PMPM down to $35.90 PMPM) and a 32% reduction in total plan cost PMPM ($76.45 down to $52.32 PMPM).

The results were clear: Navitus brought much-needed transparency to the pharmacy benefits program, creating significant savings for both the plan and members.

Getting Started

Are you interested in exploring how a truly transparent, pass-through model optimizes the experience of your members? Contact us at [email protected] to learn more.