Pharmacy Benefit Consultants is proud to have provided services to so many clients, with such success. Below is a short list of just a few of our success stories.
The State of North Dakota retained Pharmacy Benefit Consultants to conduct a contract-focused PBM RFP. Our firm worked closely with the State’s administrators for more than four months, providing the State with an in-depth claims data analysis and conducting a contract-focused RFP. Since that date, we have been asked to testify before the State Legislature on several prescription coverage matters.
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, given an existing multi-year contract that precluded termination. After several months of work, our firm put in place an entirely different PBM contract. An audit approximately 9 months after the new contract’s inception reflected the new contract had decreased the insurer’s costs by more than 14 percent. Since that date, the insurance company has relied on our firm to conduct two PBM RFPs, which reduced the insurer’s costs by mega-millions of dollars.
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. The company’s costs decreased by mega-millions of dollars after the contract’s implementation, representing a decrease in costs of more than 10 percent.
A Union Consortium with almost 300,000 members conducted a PBM RFP using another consulting firm. Realizing the firm was incapable of drafting and negotiating a PBM contract, the consortium retained Pharmacy Benefit Consultants at the end of the RFP. We put in place an entirely different PBM contract and decreased the consortium’s costs by approximately 18 million dollars. Two and a half years later, the consortium retained Pharmacy Benefit Consultants to negotiate a contract amendment, and when the PBM refused to provide improved terms, the consortium asked our firm to conduct a full-fledged RFP. The consortium’s costs decreased again. Thereafter, the consortium retained Pharmacy Benefit Consultants to audit its new contract and obtain compensation for the PBM’s failure to satisfy all terms. During the past several years, the consortium has repeatedly retained our firm, including to draft and negotiate an EGWP contract for Medicare Part D retirees, renegotiate that contract several years in a row, and most recently, to conduct two RFPs, for its “active lives” and its Medicare EGWP lives.
A Mid-West Company retained Pharmacy Benefit Consultants to conduct a PBM RFP. We drafted and negotiated an entirely different form of contract during the RFP. The company decreased its costs by approximately 18% and used its savings to open several on-site clinics. Recently, the company joined our National Prescription Coverage Coalition. The company’s costs have decreased more than 33% after implementing our Coalition recommendations, which included ending coverage for several specified high-cost drugs with far lower-cost substitutes, implementing several dozen customized prior authorization and step therapy protocols and creating a specialty drug coupon program.
Six Different Coalitions have each retained Pharmacy Benefit Consultants to advise them about weaknesses in their existing PBM contracts. Without exception, every Coalition’s contract was filled with ambiguities and loopholes, precluding the Coalitions from controlling the costs of Coalition Members. Unfortunately, without exception, the Coalitions were either stuck in long-term PBM contracts or unwilling to conduct RFPs to obtain better contract terms, meaning none of the Coalitions did anything to improve their contracts and reduce their Coalition Members’ costs.
A National Energy Lab – operating under a Department of Energy Contract – began a RFP using another consulting firm and realized the firm was unable to draft and negotiate a new PBM contract. As a result, the Lab retained Pharmacy Benefit Consultants to take over the RFP. We did so, and drafted and negotiated a PBM contract with Semi-Finalist PBMs, before the Lab selected its Finalist and implemented its new contract.
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 obtaining 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 retained Pharmacy Benefit Consultants to conduct a RFP. After a lengthy RFP with intensive contract negotiations, the 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, the union again retained our firm to conduct a RFP, and we again used the RFP’s leverage to improve the union’s substantive and financial terms and reduce its costs.