In order to ensure all participants were underwriting their proposal using the same terms, a strict minimum bid requirement was developed specifically for this group, and all bidders were required to agree to all the terms before being included in the RFP process. Once the participants were established, the fully customized RFP was distributed, reviewed and negotiated through three rounds of offers with each of the participants. Using the best and final offers from the participants, we were able to provide our client with full financial claims reprice summary, formulary and network disruption reports, and a high-level clinical summary of each offer. Using this information, the client was able to make an informed decision on who they would like to include in their finalist presentations, which would allow for a more in-depth review of each participant’s value proposition.
This comprehensive, data-driven process allowed our client to partner with the participant who was ultimately the best fit from both a clinical and account management perspective, along with generating savings of over $7MM annually through the enhanced pricing which was negotiated.
By focusing on the drug classes which are most heavily utilized within the client’s membership, primarily students, we were able to develop a fully custom formulary to remove high cost, low clinical value products from their formulary. The main classes which were identified included ADHD, Acne, Anti-depressants and Contraceptives. Working with our clinical team, we were able to create the most cost-effective formulary strategy within these classes, which included implementing:
- A high-cost generic list
- A zero dollar generic list
- Removing high-cost drugs which had lower-cost alternatives
- Through this process, we were able to save the client over $500K annually.