BKS Creates Self-funded Prescription Carve-Out Program For Child Care Client.

Our self-funded client’s prescription drug costs were increasing, and we needed to get ahead of the curve to help them keep their costs down. One way to do this is a carve-out program for high-cost medications and specialty meds.

Plan year is 6/1 and YTD savings through 11/30 have been; employer $408,000 and members $29,000

Background and Context

Containing Program Costs:

With healthcare costs on the rise and particularly prescription drugs/specialty medications, it was imperative we found a way for our client to save on projected future costs. Members are spending more money on prescriptions and sometimes forgoing them due to the high cost of the medication.

Solutions and Tactics​

  • Complete a PBM repricing analysis to determine projected savings, members impacted, and potential ROI.
  • Educated the client on how the program works and the responsibility of the members when the program is triggered.
  • Members are redirected to utilize this program for any script over $350.

Value and Lessons

  • As we monitor the performance of the program, the savings is evident with a 7.2:1 ROI.
  • Members have embraced the program knowing there are savings for them as well.
  • Utilization is easily monitored through regular reporting.
  • Scripts are zero cost to the member, encouraging them to work with the program and fill their prescriptions.

Educational and Child Care Facilities trust BKS Partners' holistic approach to provide value to their benefits programs and save members money.

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