Case Studies
MO Pharmacy
- Annual Third Party Claims
- Annual Cash w/Discount Card Claims
- Annual Cash Claims
- Total Annual Claims
- Number of Active Third Party Payers
- In business for 1 year
- Initially signed all contracts at pharmacy level
- Spent little-to-no time evaluating / negotiating
contract
- Possibly sees value of third party assistance but
would like individual consult
- 43 Active Third Party Contracts
- 28,000 Third Party Claims
- $1,100,000 in Third Party Reimbursement
- 1,818 Cash Discount Claims
- $51,000 in Cash Discount Reimbursement
RESULTS
7 contract enhancements due to joining network or avg. $120 per month savings
- 2.4 to 1 ROI
- Does not include additional rebate revenue
Reconciliation Program – 8,238 Claims
- $4,385.85 in savings
- $906.18 in program fees OR 5 to 1 ROI
MO Regional Hospital – Owns three retail pharmacies
- Annual Third Party Claims
- Annual Cash w/Discount Card Claims
- Annual Cash Claims
- Total Annual Claims
- Number of Active Third Party Payers
- Purchased two pharmacies; opened one
- Signed all contracts at pharmacy level
- Spent little-to-no time evaluating / negotiating contract – No corporate
philosophy
- Definitely seen value in consolidating assistance within one environment
- Deemed more cost-effective to outsource since there was a common philosophy
in contract execution
- 70 Active Third Party Plans (42 PBMs)
- 32 PBMs Accessible through Third Party Station
- 3 Unacceptable contracts
- 3 Required direct contracts
- 4 workers’ compensation programs (MC)
RESULTS
8 contract enhancements due to joining network or avg. $732.13 per month savings
- 4.88 to 1 ROI ($150 per month for 3 pharmacies)
- Does not include additional rebate revenue
Reconciliation Program
- Not calculated
- Enrollment in reconciliation program pending new pharmacy software system
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