Four Central Goals

  1. Improved Healthcare Effectiveness and Efficiency
  2. Greater Consumer Responsibility
  3. Healthier People
  4. Improved Economic Competitiveness

Prescription Benefit Manager

Introduction
In October 2006, the South Carolina Business Coalition on Health (SCBCH) formed a task force for the purpose of developing a recommendation on a Pharmacy Benefit Manager (PBM) strategy for the coalition.  The task force’s plan was to understand the South Carolina PBM market and then choose a plan of action most favorable for coalition members based on current market conditions.

Market Research
Initial market research indicated that the South Carolina market was as much as ten percent more expensive than more competitive markets around the country.  Because there was clearly much to be gained by creating new competition, the PBM Task Force investigated options on how to introduce a competitive contract into their market.

PBM Options
The PBM Task Force determined that there were two main options available: to go through the process of creating their own group purchasing contract or to join an existing competitive PBM contract.  While creating a group purchasing contract would allow the SCBCH to maintain the most control, it would also be a costly project due to the time and labor involved.  The task force determined that joining an existing contract allowed coalition members to immediately take advantage of PBM savings with limited administrative burdens to the coalition.  

PBM Selection  
The PBM Task Force asked SCBCH members and their brokers and consultants to provide their current PBM contracts for comparison along with a multi-coalition group contract.  After analysis of the various contract terms and service levels of the PBM deals submitted, the task force recommended that the SCBCH sign on with the multi-coalition group contract to become the group’s eighth coalition partner joining a buying group of over sixty companies and 140,000 covered lives.  The multi-coalition group contract is with Walgreen Health Initiative (WHI).  

Contract Features
The multi-coalition group contract with WHI offers SCBCH members competitive pricing (deep discounts and aggressive rebates based on contract transparency), exceptional customer service, one of the largest national pharmacy networks, a mail order program, strong reporting capabilities and excellent clinical programs that can extend contract savings through effective management of Rx.  Results from data analysis have shown savings between 8 and 12% on the overall price of the pharmacy program, depending on the structure of the company’s current PBM program.  

 

To download the survey for PBM Pricing Analysis, use the link below: