Case Study | Health Plans | PBM | PBM RFP, Analytics, Financial Modeling, Oversight
A regional health plan had partnered with the same PBM for 15 years and needed to secure more competitive services and financial guarantees for its managed retail, mail service and specialty pharmacy programs. There were several points beyond the financial agreement that the health plan wanted to improve, including administration accuracy, operational guarantees, growth support, rebate guarantee amounts and payment timelines.
Axia conducted a full marketplace RFP to identify, evaluate and select the most appropriate PBM partner for the health plan. The RFP included a select set of PBMs in the marketplace based on the client’s unique needs. The size and scope of the project included initial capabilities presentations from the bidding vendors, customizing an RFP and financial template to account for the need to in-source various functions, as well as accounting for the relationship with the health system and their own pharmacies.
Axia coordinated competitive bids from several PBMs, analyzing detailed financial and qualitative data. Axia assisted the health plan in selecting a new PBM partner.
The health plan achieved savings of 17%, or $98 million, over the 3-year contract compared to their previous contract terms. Furthermore, the PBM now aligns better with the health plan’s strategy and programs and is more responsive to arising pain points. Axia supported the health plan through implementation and offered guidance in ensuring a smooth transition and adherence to all RFP guarantees.
Axia continues to support the health plan, providing detailed utilization and discount validation reports quarterly to drive informed decision making and to hold the PBM accountable for its contracted guarantees. Additionally, the health plan regularly draws on Axia’s expertise and solutions as questions and challenges arise.
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