Opportunity
Our client had been newly promoted to president of a large TPA focused on serving colleges and universities, and had never been involved with their PBM strategy or contracts.
The TPA had three PBM contracts that did not allow the TPA to customize a solution for their clients who represented students. Also, upon our review of their contracts, we discovered they were not receiving rebates on pharmacy or medical drugs.
Solutions
Through RemedyOne’s rebate management services, RemedyOne determined the TPA should be receiving $2M a year in pharmacy rebates and $50k in medical rebates. RemedyOne implemented its medical rebate program to secure medical rebates earned by the TPA and helped secure the $2M in annual pharmacy rebates from its PBM partners in 60 days. RemedyOne also advised the TPA on how to get the PBMs to pay on prior years missed rebate payments.
Once these programs were in place, RemedyOne set out to get the TPA what it really needed: a PBM that could support a customized solution for students and ultimately a student formulary that focuses on the key therapy classes that drive health and costs for students.
The TPA moved to an independent PBM and worked with the RemedyOne clinical team, including our P&T committee, to develop a custom student formulary.
Success
Over the last 4 years RemedyOne has saved the TPA over $10M on an original pharmacy annual spend of $25M. The end result: the TPA is growing their core student business and is delivering lower costs and more access for key drugs for the student population they serve.
