Helping Our Members Save

Group Purchasing Benefits

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PBGH Employers Saved More Than $17.8M in 2017

The nationally renowned PBGH Prescription Drug Program is a self-insured, carve-out option offered to employer-members as a unique and cost-savings benefit. In 2016, more than 130,000 lives in all 50 states with a total drug spend of $230 million were covered in the PBGH program.

In fact, PBGH helped employer member companies achieve – on average – an additional 15% in prescription drug management savings – providing more than $25M in savings and just over 15 percent of total 2017 gross savings (i.e., cost), including rebates.

A significant number of PBGH employer members with more than 200 plan designs, in fact, participate in the program, which is co-managed and supported by our preferred vendor – CVS Health – via a high-caliber, PBGH-dedicated account team.

Organizations whose employee base represents 1000 and 5000 lives are also provided with a comprehensive and cost-saving prescription drug management program through PBGH’s agreement with EmpiRx Health – delivering pre-emptive action ahead of the market by employing an empirical approach to managing pharmacy benefits, with an emphasis on driving the lowest net cost, improved clinical results and concierge service for employers and members.

Value of Participation

Members benefit from the power of group purchasing while maintaining company-specific benefits and individual client support. Our PBGH dedicated Caremark account team ensures accountability, actionable information and proven results.

 

Financial Terms

  • Annual Market Check to guarantee “best in class pricing” with additional savings annually
  • Aggressive, flexible discounts and rebates, no reserves
    • Discount Guarantees: Point of Sale and Annual
    • Guaranteed Rebates: All brands paid quarterly
    • Maintenance medications up to a 90-day supply: CVS stores or mail service
  • Traditional and transparency options
  • Guaranteed Contract Performance: Annual, independent third-party audit managed and paid for by PBGH

 

Employer Member Support & Resources

  • Seamless, well-defined implementation process with performance guarantees
  • Dedicated and local, tenured and experienced strategic account team
    • Strategic account executive, account managers, clinical pharmacists, member services, analytics and outcomes services, reporting, communications, finance, legal, audit team
  • Key account designation with designated executive liaison
  • Regularly scheduled strategic employer meetings leveraging Caremark’s expertise and resources
    • Account management recommendations designed to assist in achieving “Best-in- Class”
  • Personalized analysis and reporting includes online, ad-hoc and customized reporting at no additional cost
  • Benchmark comparisons: industry, PBGH Best in Class employer members and PBGH aggregate
  • Health savings account (HSA) expertise and administration: real-time integration with medical plan administrator
  • Employer-specific and PBGH-tailored performance guarantees including annual company-specific risk allocation
  • Semi-annual leadership meetings for networking and shared learning with fellow employers and keeping ahead of the curve with industry leaders and subject matter experts

 

Impacting Trend

  • Core clinical solutions targeting cost savings, safety, adherence and health management with no additional fees
  • Enhanced clinical management solutions with employer-specific return on investment guarantees
  • Specialty pharmacy preferred programs and care and guideline management options
  • Member service, support and engagement with personalized and targeted communications
  • Prescription Savings Guides provide individual savings analyses for employers and their participants
  • Designated customer care team with the PBGH toll free telephone number for members

Contact Diane McClune, 724-775- 1613, diane.mcclune@pbghpa.org to discuss how your organization can participate in the Prescription Drug Program.

EmpiRx

Transforming Rx Benefits One Prescription at a Time

PBGH is revolutionizing the way pharmacy benefits are being delivered by ensuring employers and members save money by obtaining the appropriate drug at the right time and best channel.

Our commitment is simple: Obtain the lowest net cost per prescription while delivering the highest quality of care in a fully aligned and transparent fashion. Our proactive solutions keep advisors and their clients ahead of today’s pharmacy market changes.

Through collaboration and partnership with EmpiRx Health, PBGH will deliver a best-in-class experience that improves the overall client and member experience.

 

Evidence-Based Clinical Management

Appropriate formulary and clinical programs, which are in alignment with the financial interests of the advisor, client, and member, preserve bene t dollars ensuring lowest net cost and improved patient health rather than maximization of rebates.

Lower costs utilizing industry leading evidenced-based clinical protocols with unique “dollar for dollar” guarantees and auditable reporting.

Value-added medical and pharmacy integration to improve overall health care outcomes and to bridge the gaps of traditional carve-out arrangements.

The PBGH Right Rx Program

The Best RX For Lower Plan and Member Costs

US-Rx Care provides “Pharmacy Benefits Risk Management” services to entities that bear pharmacy risk. US-Rx Care’s expertise includes all aspects of pharmacy management, including acute, chronic, and specialty medications.

Over the last 20 years, US-Rx Care’s Right Rx program has produced significant savings in drug expenditures for self-funded employers and health insurance plans covering more than 4 million lives throughout the U.S.

 

How It Works

PBGH provides advocacy and outreach on behalf of self- funded plans to maximize client and member savings, while also maintaining or improving quality of care.

The Right Rx Platform efficiently reviews client pharmacy claims data and recommends lower cost therapeutic equivalents to prescribing doctors.

When prescribers approve lower cost therapies, members are contacted by PBGH’s trained advocates and educated about the cost saving therapy changes. New prescriptions for doctor- approved alternatives are forwarded to the member’s pharmacy for doctor and member convenience.

 

Cost Savings Guarantee

ALL PBGH clients save money by implementing the Right Rx program, a fact, which we gladly back with a savings guarantee.

In the unlikely event that program savings do not exceed program costs, we will refund the difference.

A guarantee as unique as is the effectiveness of the Right Rx program.

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