Case Study | Health Plans | PBM | Market Check/Marketplace Evaluation, Proprietary Database


A regional health plan representing approximately 180,000 lives across multiple lines of business needed a stronger contract with its incumbent PBM. After a long-term relationship with the PBM and not engaging with a consulting partner in the past, the contract was no longer competitive compared to what was being achieved in the current marketplace.


The health plan retained Axia to perform a mid-contract market check. Based on the existing scope of the health plan’s contract language, Axia utilized its proprietary database to evaluate the pricing and contract terms of clients similar in size, geographic market, scope and business segmentation to the health plan.


In addition to assessing pricing opportunities, Axia also addressed several of the health plan’s pain points, including the right to renegotiate prices should the health plan’s membership increase. Additionally, Axia facilitated improved contract language and performance guarantees. This market check resulted in $18 million (6%) savings over the client’s remaining contract term.

The health plan continues to utilize Axia’s guidance and reporting to keep its pharmaceutical benefit competitive and looks forward to seeing its contracted discount guarantees improve even more as it continues to expand and grow.

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