Major employer with 450k lives saves $30MM and enhances PBM negotiations
Client: Major U.S. Employer
Industry: Communications
Challenge
The employer’s vast size meant its pharmacy management challenges were more complex than those of smaller organizations. Unfortunately, they lacked visibility into their Pharmacy Benefits Manager (PBM) performance. A large organization like this benefitted from going beyond periodic PBM audits to improve visibility into contractual adherence and better mitigate financial risk.
Approach
When the employer switched to a new PBM, they engaged Milliman to help with the transition. With rising costs and intricate plan designs, they needed precise, near-real-time validation of their financial guarantees. Milliman implemented SkySail, a versatile data analytics platform that delivers ongoing monitoring, clinical insights, and pharmacy benefit expertise.
Milliman set up the employer’s diverse plan designs in SkySail for daily monitoring of network and dispensing guarantees, AWP discounts, MAC performance, rebates, and specialized rates.
Impact
SkySail’s precision and efficiency combined with Milliman’s expertise, enabled the employer to identify and recoup more than $30 million in actual errors immediately. This timely detection and rectification helped the employer avert financial discrepancies that could have amounted to over $100 million. The employer now has the insights to effectively negotiate with its PBM and maintain a healthy and collaborative partnership.
Learn more about what Milliman SkySail can do for you.