The Challenge

The medical prescription spend for a western Pennsylvania university was spiraling out of control. The per employee per month (PEPM) drug cost for specialty medications accounted for nearly 50% of the total medical/Rx claim cost. In 2020, the university faced a high double-digit increase from their benefits provider with no programs to mitigate rising costs.

The Solution

With the guidance and analysis of the Henderson Brothers’ Benefits Practice, the university moved to a self-funded arrangement, implemented Benecon to cap monthly costs, carved out the drug, and implemented a specialty drug savings program. These moves proved highly successful, as the PEPM drug cost dropped by $100 in the first six months of the plan year. The cost savings is now $115 compared to the previous year.

A drug utilization comparison from 2020 to 2021 shows a substantial prescription claim savings of $163,500. Total Claims in 2020 (net rebates) totaled $334,227, while they were reduced to $170,727 in 2021.

Learn More

To learn more about how Henderson Brothers’ Benefits Practice can partner with your team, please contact Sean Ganoe at (412) 754-3215 or [email protected]

Please note that the information contained in this posting is designed to provide general awareness in regard to the subject matter covered. It is not provided as legal, medical, or tax advice, nor is it intended to address all concerns in your workplace or for public health. No representation is made as to the sufficiency for your specific company’s needs. This post should be reviewed by your legal counsel or tax consultant before use.