When was the last time someone actually analyzed your prescription drug claims?
If you’re like the employer we recently met with (3,400 employees, loyal to their broker, happy with the service) you might not even know what a pharmacy assessment looks like. This employer had never seen their drug spend data. Didn’t know where to find it. Had no idea that prescription drugs were consuming 25% of their total benefits spend.
That’s not an accident. That’s a choice your broker is making.
The Numbers Don’t Lie
Ten years ago, pharmacy claims represented maybe 12-14% of total spend. Today? It’s 20-25% on average. We’ve seen cases where it’s over 50%.
Let that sink in. Your second or third largest business expense is growing exponentially, and most brokers aren’t even showing you the data.
Real Money, Real Savings
We’re currently working with an employer who has about 1,500 employees. On just six medications (same exact drugs, same brand name, same packaging, US-based pharmacy) we found over $1 million in potential savings.
Not from overseas. Not from switching to inferior alternatives. The exact same medications at a fraction of the cost.
This employer works with a top-25 national broker. They have all the resources to do this work. But they don’t.
Why?
The Red Flags
If you have 50+ employees on your health plan (fully insured or self-funded) and your broker hasn’t done a deep dive into your pharmacy claims, especially specialty medications (the ones costing hundreds or thousands per month), that’s a massive red flag.
Unfortunately, brokers typically hit the easy button. They push a spreadsheet. Maybe shift some costs around. Negotiate a slightly lower renewal and call it a day.
That’s lazy. And it’s costing you serious money.
Take Control of Your Data
You’re spending tens of thousands, hundreds of thousands, maybe millions on your benefits program. You deserve the data.
If your broker isn’t showing it to you, ask for it. If they can’t provide it, go straight to your insurance carrier: Blue Cross, United, Aetna, Cigna, whoever. They’re legally required to give it to you.
And here’s the thing: Pharmacy assessments don’t need to wait until renewal. They can be done mid-year. That means savings could start flowing back to your bottom line in weeks, not months.
The Bottom Line
Whether you’re fully insured or self-funded, there are ways to dramatically reduce your prescription drug costs. But you’ll never know what’s possible if you’re working with someone who won’t do the work.
DM me for more information on how a pharmacy assessment could uncover six or seven figures in savings sitting in your benefits program.