Evaluation of Consultant-sponsored PBM Coalition/Collaborative Agreement
A large employer client was increasingly concerned about the lack of transparency and clarity in their Collaborative agreement through one of their consulting firms.  They desired to compare their current agreement to the marketplace to determine if they were getting the best deal possible.  Burchfield worked with the client to develop a strategy for conducting a Request for Proposal (RFP) for PBM services that allowed the client to compare results, despite the restrictions the Collaborative had in place preventing Burchfield to access the Collaborative’s PBM agreement.  Burchfield’s modeling tools allowed the client to have insight into their current agreement and evaluate it against others in the marketplace, while maintaining the confidential terms.  Ultimately, this client left their collaborative arrangement and found a more favorable stand-alone agreement.

Market Check
A national employer client engaged Burchfield to conduct a market check, which allows clients to compare their current PBM financial agreement against similar companies in the marketplace.  If the market check proves that the current financial agreement is not competitive, the PBM would provide a more viable financial offer.  Market checks are standard provisions within PBM contracts; however, they generally require that comparisons are valid only when made between companies of similar sizes and demographics of covered members.  Our client had a very unique member population that made it difficult to find similar companies that would be approved by the PBM.  Burchfield was able to develop a strategy to solicit a financial proposal from a competing PBM, using the client’s actual data and drug mix.  This analysis resulted in the potential for over 10%  in annual savings for the client over the remainder of the contract.

Audit Recovery
Burchfield conducted a pricing audit for an employer client that determined the client was owed nearly two hundred thousand dollars by the PBM for not meeting financial guarantees.  The PBM contested the audit results, stating that the contract language allowed them to offset a shortage in one area with an overage in another area, thereby eliminating any amounts owed.  Burchfield supported the client through negotiations to recover the amounts owed, and was able to provide documentation from the PBM RFP process that supported the client’s position.  In the end, the client recovered the funds owed to them by the PBM.