A pharmacy analysis was performed for a California employer receiving pharmacy benefits bundled through their medical carrier. The incumbent program lacked accountability with no contract guarantees, limited insight on Rx claim utilization, and restricted payment validation.
WINNING THE BID: HOW BOUTIQUE BEAT NATIONAL
Barbara Grundy Evans2025-01-20T23:21:17+00:00Winning the Bid: How Boutique Beat National Saved more than $1.3 million vs renewal Showed a 2% increase vs current rates Pre-identified 4 members for alternative med & Rx savings programs The Situation One of our broker partners runs a [...]
SELF-FUNDED PLATFORM: CONTROLLING COSTS AT RENEWAL
Barbara Grundy Evans2025-01-20T23:22:35+00:00Self Funded Platform: Controlling Costs at Renewal Increased surplus retained from $0 to $1.7 million in one year Reduced claims spend by 47% over one year Saved more than $350,000 in claims through med & Rx intervention The Situation One of [...]
RISK REDUCTION: ELIMINATING $800K OF CLAIMS EXPENSES
Barbara Grundy Evans2025-01-20T23:52:33+00:00Risk Reduction: Eliminating $800k of Claims Expenses Initial fully-insured renewal from carrier Identified 2 high-cost claimants Crumdale’s risk control brought the group’s renewal to 12% The Situation A lumber company in the Northeast had been offering a fully insured medical [...]
SPECIALTY RX SOLUTIONS: COST MANAGEMENT
Barbara Grundy Evans2025-01-20T23:56:02+00:00Specialty Rx Solutions: Cost Management Total reduction in NET medication costs $17,300 in per month savings for the plan & member Reduced total medication cost to $700 per month The Situation One of our brokers had an industrial client who [...]
PBM CARVE-OUT PLAN: SAVING NEARLY $3 MILLION IN A YEAR
Barbara Grundy Evans2025-01-20T23:57:31+00:00PBM Carve-Out Plan: Saving Nearly $3 Million in a Year Savings due to improved discounts Unlocked hidden and improved rebate value Client’s total savings The Situation One of our brokers had a city government client in the Southeast who felt [...]
CLAIMS MONITORING: ACTIVELY IDENTIFYING SAVINGS
Barbara Grundy Evans2025-01-20T23:58:29+00:00Claims Monitoring: Actively Identifying Savings Identified and re-priced by Crumdale for higher discounts The amount originally requested from the group by the TPA Savings when in-network claims were correctly processed with only $3K due from the group, NOT $45K+ The Situation [...]