Case Study | Health Plans | PBM – Medicaid | Single Vendor RFP, Negotiation
A health plan based in the Northeast requested an improvement to their current PBM arrangement to meet the strategic and regulatory demands in the Medicaid marketplace and reduce overall plan costs. The incumbent PBM requested a single vendor RFP response for a potential renewal. This health plan sought a competitive renewal and contract extension offer without the requirement to go through the more involved process of a comprehensive marketplace RFP; however, the health plan still reserved the right to perform a comprehensive RFP if the financial results of the process did not meet marketplace benchmarks developed by Axia.
Axia requested a proposal for the continued performance of the incumbent PBM and emphasized the need to address specific pain points, such as support around state Medicaid requirements as well as strategic support around their custom formulary and clinical programs to reduce overall plan spend. Axia benchmarked the proposal against the marketplace for similarly sized and market positioned government-based clients.
After several rounds of negotiation, Axia secured a proposal from the PBM that addressed the client’s pain points and improved the current contract terms, 4%, resulting in $10 million in savings.
Axia offers continued support, working in conjunction with the health plan and the PBM to provide contract review and negotiation, ongoing validation and monitoring of the new contract and resolution of any arising difficulties through ongoing vendor management.