Reducing Pharmacy Spend for Self-Funded Plans

A large global oil and energy company had very high medical and pharmacy claims. As part of their solutions to decrease their costs, they eventually became self-funded. However, they continued to experience costs that were higher than desired. And while being self-funded put them in the driver’s seat for controlling costs, it also meant they were the ultimate decision-maker, with the responsibility of understanding current health care trends and meeting applicable federal regulations (ERISA).

They lacked assurance that that they had an optimal benefits program in place in terms of competitiveness, cost containment, and compliance.

In 2014, Crystal & Company became the company’s benefits consultant and advocate. We immediately went to work benchmarking their current program and performing a utilization review and financial forecasting. We brought different program configurations to the table, and crafted a customized benefits plan to meet their financial, regulatory and coverage needs. By fine-tuning their benefits options and moving them from a single-option to a dual-option plan (with a “base” and a “buy-up” plan), during the first year of implementation, the company saved 15 percent over the previous year.

We also proactively sought out alternative pharmacy solutions—to keep their costs down while maintaining the quality and competitiveness of their program. We implemented a new pharmacy benefit management program, with projected annual savings of $200,000, or 32.6 percent of their annual expected prescription costs. We continue to manage and oversee the program and report its effectiveness on a quarterly basis, assuring that we meet the projected savings.

In a constantly evolving health care marketplace, we continue to look for innovative ways to maintain benefits solutions that observe the company’s fiscal health and meet employee expectations.

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