Carving Out Prescription Benefits

A skeptical employer gains control of its prescription benefits and protection from rising prices.

THE CHALLENGE

A division of a Fortune 200 company relied on a respected health plan for both medical and pharmacy benefits for several years. But as the group grew and the cost of drug benefits increased, they considered contracting separately, or carving out, the pharmacy component of the benefit. A carve out would give the company more clarity and greater control over features and costs. It could also give it a better view into the utilization of its employee population and, in doing so, shed light on ways to bend the cost curve down.

But on the HR team, there were skeptics. Would this add to their workload? Would the health plan and PBM effectively communicate with each other?  Were they inviting administrative headaches? How would they handle employee/member phone calls about exceptions, denials and other problems? Could the labor involved in prior authorizations alone derail other initiatives?

Carve out proponents in the company prevailed. After considerable due diligence and a competitive process, the company selected Abarca.

THE APPROACH

Abarca assigned a team with the skills and resources necessary to design a pharmacy benefit that would keep costs down, and provide a stellar member experience, all without adding to the workload of the HR team. The new solution was implemented in only 45 days.

THE RESULTS

Abarca’s call center efficiently handled inquiries from employees, providers and pharmacies, allowing the client HR team to focus on other business priorities. The HR department received detailed financial analyses through an easy to understand dashboard and business intelligence tools. And through a combination of formulary management, pharmacy network design, channel management, and negotiations with pharmaceutical companies, Abarca effectively kept inflation to 3% or less for the next two years.

The skeptics were won over. Managing the program was as easy as ever, and savings and satisfaction grew thanks to better tools and a partner that was transparent, trustworthy and 100% committed to finding a better way.

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