A national mid-sized plan retained Truveris to assess the competitiveness of its current PBM relationship and help it secure the best pharmacy contract and terms going forward. The company had been with the same PBM for nine years and was concerned because, each time its PBM contract was up for renewal, the plan had no way to gauge whether the new contract offered by its PBM was a good deal.

In using TruBid, the client realized how simple yet robust the automated RFP platform is. This client provided Truveris with a basic profile on its plan design and contracting needs/desires as well as its existing PBM contract and claims data. Upon receiving bid responses from the PBMs, TruBid replicated each bid’s performance with the plan’s actual claims data as well as with projections based on the plan’s drug spend trends and Truveris industry expertise. This allowed TruBid to confirm which PBM bid was the best financial option for the client.

The plan was more than happy with the savings achieved thus far, but TruBid went a step further. In a second round of bidding, the competing PBMs could view the blinded bids submitted in the first round. With this level of financial transparency compelling the PBMs to provide their most competitive bids, the client was pleasantly surprised by the final results.

TruBid produced an objective scorecard that summarized the RFP results and provided explanations for each PBM’s score. The results of the analysis substantiated a clear winner based on the qualitative considerations and financial results. In the end, the plan switched to a different PBM, received clear "apples-to-apples" contract terms and the most competitive financial guarantees, and saved 12.7% on total drug spend—all from a process that took 23 days.

A Fortune 500 company was concerned about its lack of resources to properly review its pharmacy bills before paying them, especially as drug spend continues to rise. As a self-insured corporation and fiduciary of its benefit plan, the company also has an obligation to its members to ensure plan integrity.

This company thus engaged Truveris to review its pharmacy bills, both for cost accuracy and plan integrity. However, the client’s PBM pushed back on providing the necessary data for bill review, claiming that doing so constituted an audit. The client’s Director of HR responded by asserting that “this exercise is considered a ‘bill review’ and not an audit” – any payer has the right and the responsibility to review its bills before they are paid.

The client also wanted to access historical prescription claim data from a previous PBM plan for analysis but was informed that accessing its own data would cost $50,000 in extraction fees. This was not acceptable to the client, who has now chosen to use TruGuard data storage capabilities, which allow the client unlimited and secure access to its data.

Finally, the TruGuard analysis gave the client insight on how both its plan and members were being overcharged.

The overcharge errors resulted in total savings to the client of $413,712, or 2.89% of its drug spend. The analysis also showed that the client’s consumer-driven health plan and coinsurance design averaged 38.79% cost share for its members. Thus the billing errors translated to member overcharges of $160,478. With approximately 1,300 affected members, this translates to an average of $123.44 overcharge per member.