2021 // Issue 3

Consultant Connections is a quarterly newsletter, specifically for employee benefit consultants, dedicated to providing details and data needed to help employer clients maintain high-quality care for their plan participants while keeping prescription drug and related health care costs sustainable.

From Mike

Autumn is a busy time, so I’ll (try to) be brief!

THANK YOU to those consultants who have provided opportunities this sales season and for those who have entrusted us through the award of business. As of this writing, we have secured over $220 million in new pharmacy spend for the year!

We’ve been working with our pharmacy benefit management (PBM) suppliers to rebalance the Maximum Allowable Cost (MAC) pricing schedule to ensure all generic drugs have a competitive price. With new transparency offered by public data such as the National Average Drug Acquisition Cost (NADAC) or apps such as GoodRx, we’re able to find outliers and uncompetitively priced generic drugs and work with the PBM to adjust these price points to ensure participants are getting value. We believe this to be a less disruptive move for participants versus changing to a cost-plus price benchmark where the dispensing fee can be higher than the original price of the drug, particularly for high-volume, highly-discounted generics.

The market check will be complete and distributed by the time you get this edition of Consultant Connections. We are behind our desired timing this year. That’s the bad news. The good news is that some early summer market dynamics provided an opportunity for us to negotiate additional value into this year’s market check and most clients will see a higher-than-normal pricing improvement for 2022.

Finally, please be sure to familiarize yourself on our new offering with Quantum Health. For those clients looking for real value from true integration, all while using best-in-class benefits suppliers, this is a great option to consider.

My very best for a productive, healthy and safe fall season!

Michael Stull
Chief Strategy Officer

Market Check

ach fall, Employers Health begins its work to prepare for the annual market check. This includes utilizing a third party to benchmark our contract, analyzing and projecting mid-year data and synthesizing the results of the previous sales year. Our goal is to attain the most aggressive and market competitive pricing for Employers Health clients, while maintaining the clean and straightforward contract our clients and their consultants have come to appreciate.

For the 2022 market check, Employers Health secured pricing improvements that average high-single to low-double digits. While we desire to deliver these results in early summer, shifting market dynamics demanded further negotiation for better terms. This required more time but resulted in even more aggressive pricing.

While some direct contracts and other coalition arrangements also provide a market check, one of the big differences for Employers Health is that we’re negotiating with more leverage each year due to our significant growth. As the market consolidates, individual entities lose negotiating leverage if they are not part of a larger group. We see this not only play out in the employer market, but with PBMs and health plans as they look for ways to purchase together and improve their respective market positions.

As the 2022 market check comes to a close, our team will begin preparing for 2023 negotiations. We expect there to be numerous discussions around the specialty space again, with a focus on the individual prices for specialty generics and how the PBMs ultimately will handle new biosimilars that are expected to come to market. As an employer-led purchasing coalition, we’ll look to find the right combination of price, flexibility and clinical management that provides the most benefit to our shared clients!

New Solution Spotlight: Quantum Health

We hear it frequently; plan sponsors are looking to integrate. They want one number to call and one website to access. As we detailed previously, there are pros and cons to this approach. For employers on the fence about which approach to take, we are excited to offer a custom navigation solution, with exclusive terms just for Employers Health clients.

After an extensive vetting process, we have selected Quantum Health and its innovative approach for self-insured employers combatting rising medical and pharmacy benefit costs. Plan sponsors and their participants will achieve improved member engagement, positive clinical outcomes and meaningful savings via Quantum Health’s award-winning, proprietary health care navigation solutions. Quantum provides a seamless approach for self-insured employers utilizing their existing benefit offerings. With one number to call, employers and employees have a single point of contact for all their benefits needs. Members are guided by a team of care-coordination experts with access to their employer’s full suite of benefit solutions.

Because no one should have to navigate the complex world of health care alone, Quantum Health provides a service that members appreciate, particularly when trying to find the right care for themselves or a loved one. As a navigation partner, Quantum’s Real Time Intercept™ model utilizes provider, member and industry data to evaluate interactions and engage members up to 120 days before a claim is received. This revolutionary technology is proven to reduce a plan sponsor’s health care cost by an average of 9% in three years versus the industry cost trend.

Have a client evaluating their medical benefit? Please contact us to learn more about how it may benefit from this custom offering.