2022
PHARMACY
BENEFITS REVIEW

Aligned Interests
Sustainable Results

In 1995, human resources and benefits professionals from Employers Health clients realized group purchasing for pharmacy benefit management (PBM) services created efficiencies that would maximize the value of their benefit plans. Today, more than 275 plan sponsors in 37 states benefit from these synergies created 27 years ago.

As the health care industry continues to consolidate, employers and plan sponsors look for ways to maintain leverage in this volume-driven business. Group purchasing using an employer-founded, employer-led collaborative with a proven track record of success provides plan sponsors leverage without the risks of misaligned business objectives, hidden contractual terms and conflicts of interest. Clients benefit from group purchasing programs that are aligned with the needs of plan sponsors, transparent in their terms and widely scrutinized by benefit consultants and advisors. Plan managers and their participants achieve value in the form of better outcomes, better experiences and better costs evidenced by the growth and retention of the Employers Health client base.

As we continue to grow, employers continue to benefit. We invite you to look back on the success clients achieved as part of our PBM group purchasing programs in 2021.

Market Dynamics

  • The market continues to consolidate resulting in a continual loss of choice, flexibility and negotiating leverage for employers.
  • Specialty medications and increased approvals of high-priced, new medications continue to significantly drive rising trend.
  • State and federal legislation highly focused on drug pricing, patient affordability, rebates and transparency.
  • Utilization spend on COVID-19 vaccines reduced generic dispensing rates by eight percentage points!

2021 Employers Health Book of Business

$1.87B Gross cost

$10141 Gross PMPM including rebates

-0.3% Total gross trend including rebates

41.7% Specialty as a percent of total

81.4% Generic dispensing rate (GDR)*

6.33% Brand price inflation

1.47% Generic price inflation

$1.50 COVID-19 vaccine impact PMPM

35 Days' supply PMPM

46 Average plan participant age

*inclusive of COVID-19 vaccine

91%9%
BroadRestricted
49% 31% 20%
Restricted 90-day
(mail plus 1 major chain)
Mandatory Mail Open
98% 2%
Exclusive Open
99% 1%
Yes No
95% 5%
Yes No
27% 73%
Yes No
90% 10%
Yes No
100%
Yes

Top 3 Classes

1

Antidiabetics

2

Analgesics/
Anti-Inflammatory

3

Dermatologics

Peak Performance

Better Outcomes

Growing client base and team drive greater value.

  • 43 new clients.
  • 275+ plan sponsors, in 37 states, covering more than 1.2 million lives.
  • New clients added $258 million+ in pharmacy spend bringing our total spend to $2.2 billion.
  • 180+ evaluations in 2021 by most major pharmacy consultants for new business.
  • Improved care for patients with chronic disease.
  • Elimination of waste, ensuring appropriate use and excluding high price, low-value drugs.

Better Experiences

First-class experience for clients each time, every time.

  • 4.8 client-satisfaction score on a 5-point scale.
  • 99% of client satisfaction survey respondents plan to renew.
  • 99% of client satisfaction survey respondents would recommend EH to a peer.
  • A team built to enhance results and improve the experience of clients.
  • Behind-the-scenes work with CVS, OptumRx and Elixir to proactively find solutions for clients.
  • Custom clinical and utilization management solutions to meet plan sponsors’ needs.

Better Costs

Helping clients achieve their goals by minimizing and flattening trend.

  • Annual pricing negotiations offset drug price inflation and contribute to single-digit trend.
  • Integration of Rx claims with medical carrier.
  • Our legal experts negotiate prudent contract terms paired with industry-leading pricing.
  • Annual 100% claims audit by a third-party auditor, of which findings and recoveries attributable to specific plans are passed back 100%.
  • 5-7% average annual pricing improvement.