Accomplishments

Pharmacy Benefit Consultants has worked - or is currently working - for the following entities, among others, on the following projects:

The State of North Dakota retained Pharmacy Benefit Consultants to conduct a contract-focused PBM RFP to enable the State to evaluate whether it wanted to carve-out its prescription coverage program for all state employees. Our firm worked closely with the State’s administrators for more than four months, providing the State with an in-depth analysis of its coverage, as well as the means to improve that coverage by demanding an entirely different set of contract terms.


A Medicaid Insurance Company retained Pharmacy Benefit Consultants to draft an entirely different form of contract, and to negotiate one-on-one with its existing PBM.  A quick audit approximately nine months after the new contract’s inception reflected the new contract had decreased the insurer’s costs by  (a) more than 7% (without taking into account the impact of drug manufacturers’ increased prices), and (b) more than 14% (if the impact of drug manufacturers’ increased prices was eliminated).  At the end of the first year of the contract, the insurance company asked Pharmacy Benefit Consultants to assist the company in taking advantage of contract provisions to renegotiate and improve contract pricing terms and guarantees.


A Fortune 100 Company retained Pharmacy Benefit Consultants to analyze its current PBM contract’s weaknesses, construct a targeted audit, and thereafter conduct a RFP to obtain a better PBM contract.


A Union Consortium – representing almost 300,000 members – conducted a PBM RFP and retained Pharmacy Benefit Consultants to negotiate and draft a new PBM contract at its conclusion. Two and a half years later, the consortium again retained Pharmacy Benefit Consultants to negotiate an amendment to the contract, and when the PBM refused to provide improved terms, to conduct a full-fledged RFP. Thereafter, the consortium retained Pharmacy Benefit Consultants to audit its new contract and to insist upon compensation for the PBM’s failure to satisfy the airtight contract terms that had been negotiated. During the past several years, our firm has repeatedly been retained to work with the union Consortium, including to implement an EGWP contract for Medicare Part D eligible retirees, renegotiate that contract several years in a row, and finally to conduct a Medicare Part D RFP.


A Mid-West Coal Company retained Pharmacy Benefit Consultants to conduct a PBM RFP. We drafted and negotiated an entirely different form of contract during the RFP that saved the company so much money that it was then able to open on-site clinics at each of its coal sites. Recently, the company joined the National Prescription Coverage Coalition. Its costs decreased more than 34% after implementing our Coalition recommendations.


A Mid-West Business Coalition retained Pharmacy Benefit Consultants to advise the Coalition about weaknesses in its current PBM contract, make recommendations concerning the scope of an upcoming audit, and conduct a RFP to locate a PBM auditor.


A National Energy Lab – operating under a Department of Energy Contract – began a RFP using another consulting firm and, realizing the firm was unable to draft and negotiate a new PBM contract, thereafter retained Pharmacy Benefit Consultants to take over and conclude the RFP.


A Mid-West Insurance Company retained Pharmacy Benefit Consultant’s CEO, Linda Cahn, to conduct litigation against the insurer’s former PBM concerning wrongful and inaccurate generic pricing and rebate practices. After prosecuting the case for more than a year – and extracting tens of thousands of documents reflecting questionable practices – the litigation was settled, resulting in a significant payment to the insurance company.


A large policemen’s union and major transit workers group each retained Pharmacy Benefit Consultants to conduct RFPs. The latter replaced its existing PBM and saved significant sums. The policemen’s union chose to retain its incumbent PBM, but dramatically improved its contract terms, and thereby saved millions of dollars annually. Following several years of annual audits conducted by our firm, the policemen’s union retained our firm to again conduct a RFP, and we again used the leverage of the RFP to improve the union’s substantive and financial terms.


Articles in “Benefits” Magazine: Our CEO, Linda Cahn, has authored numerous articles for the widely disseminated magazine of the International Foundation of Employee Benefit Plans, including two cover stories: “Ten Ways To Navigate An ‘Airtight’ PBM Contract”, and “How To Conduct A Successful PBM RFP”. Cahn has also authored numerous other articles for “Benefits” magazine, including: (i) “PBMs’ MAC Mousetraps”; (ii) “Specialty Drugs – So Special It’s Time To Control Their Costs”; and (iii) “Say ‘Yes’ To Programs To Control Drug Use.”


Featured Articles In Leading Magazine: The highly regarded magazine, Managed Care, has also carried numerous stories written by Pharmacy Benefit Consultant’s Linda Cahn, including the following: (i) “How to Dramatically Decrease Your MCO’s Rx Coverage Costs”; (ii) “Don’t Get Caught By PBMs’ MAC Mousetraps”; (iii) “Don’t Get Trapped By PBMs’ Rebate Labeling Games”; (iv) “Brand Drug – Generic Drug”; (v) “Don’t Pay Too Much for Generic Fills”; (vi) “How To Combat Pharma’s Costly Coupon Programs”; and (vii) “When It Comes To New Drugs, If Payer’s Snooze, They Lose.”


Cover Story In Employee Benefit Adviser: In a cover story captioned “Seeing Clearly”, Employee Benefit Advisor described Linda Cahn’s leading role in trying to end consulting firms’ Conflicts of Interest.


Recurring Citations As Industry Expert: The nation’s leading  newspapers, including the New York Times, Wall Street Journal, LA Times, Barron’s, AP and Reuters have repeatedly quoted Linda Cahn in stories related to prescription coverage. Leading trade journals, such as Drug Benefit News, Pharmalot and STAT, have also quoted Cahn, including in the following articles: (i) ”PBMs Allegedly Manipulate Definition of ‘Brand’ and ‘Generic’ Rx at Payers’ Expense”; (ii) “PBM Auditing Increases As Rx Costs Rise, But Critics Allege PBMs Are Foiling Audits”; (iii) “PBMs Tout Their ‘Transparency’, but Model Doesn’t Always Lower Clients’ Drug Costs”; and (iv) “Rx Coalition Deal With Envision Promises Aggressive Discounts.”