One Health System’s Journey to Address Unsustainable Pharmacy Costs
Discover how a 1,300-member organization achieved significant pharmacy cost savings without disrupting employee care.
When you manage a hospital or health system, balancing top-tier employee benefits with your bottom line can feel like an uphill battle. You want to offer excellent care to your team, but soaring prescription prices often stand in the way.
Here is how a health system partnered with us to transform their benefits plan and drastically reduce pharmacy costs
The Challenge: Skyrocketing PMPM Spend
The health system faced a critical financial hurdle: unsustainable annual pharmacy expenses and an excessive Per Member Per Month (PMPM) spend. The financial burden of high-cost, low-value medications threatened their budget.
They needed a strategic partner to help them reduce pharmacy costs and improve employee health. They also needed an expert team capable of navigating the unique, complex pharmacy benefit challenges inherent to hospital environments. The goal was clear: lower expenses without negatively impacting the members who rely on these vital medications.
The Solution: Health System Pharmacy Optimization
To tackle these challenges, we implemented a tailored approach to optimize the health system’s pharmacy benefits. Our strategy minimized financial waste while limiting member impact through three core actions:
Formulary Optimization: We excluded high-cost, low-value drugs to immediately eliminate unnecessary spending from the plan.
High-Dollar Claim Reviews: Our clinical experts carefully reviewed expensive medications to ensure cost-effective, clinically sound alternatives were utilized.
Manufacturer Assistance Programs: We leveraged available funds and manufacturer programs to lower the out-of-pocket costs for both the health plan and the individual members.
The Impact: Maximum Savings, Minimal Disruption
By implementing the RxBenefits clinical Protect program—specifically designed for the nuanced needs of hospital clients—this health system achieved remarkable financial relief. They secured significant pharmacy cost savings while ensuring their employees experienced minimal disruption to their daily lives and care routines.
Ready to Optimize Your Pharmacy Benefits?
You do not have to choose between providing great employee benefits and maintaining financial stability. Let us help you find the right balance.
