Reducing Rising Pharmacy Costs
Since 1995
Employers Health has worked to reduce pharmacy benefit costs for employers and employees since 1995. Through the collective power of group purchasing for pharmacy benefit management (PBM) services, employers maximize the value of their benefit plans while providing employees and their families with affordable health care benefits. What started as a local initiative to contain pharmacy costs in Northeast Ohio has become one of the nation’s leading group purchasing organizations covering more than 1.9 million lives. Today, more than 400 plan sponsors in 42 states benefit from these synergies created decades 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 sponsors 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.
Market Dynamics
State legislation is focused on reimbursement, network composition and rebates.
The market continues to consolidate resulting in a loss of choice, flexibility and negotiating leverage for employers.
Biosimilars for the world’s highest-grossing medication, Humira, provide opportunities for cost savings.
Lower prices for insulin products will benefit individual patients and reduce rebates for plans.
Premier Performance
Better Experiences
First-class experience for clients each time, every time.
- 4.8 client-satisfaction score on a 5-point scale
- 87 Net Promoter Score
- 99% of client satisfaction survey respondents would recommend Employers Health to a peer
- 97% of client satisfaction survey respondents said Employers Health makes the PBM experience better
- Dedicated team to enhance results and improve the client experience, working behind-the-scenes with CVS and Optum Rx 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.
- Employers Health legal and PBM experts negotiate one of the most competitive deals in the industry
- Annual pricing negotiations offset drug inflation and contribute to single-digit trend
- Two-thirds of clients experienced single-digit trend
- Integration of Rx claims with medical carrier
- Annual claims audit by a third-party auditor, of which findings and recoveries attributed to specific plans are passed back 100%
- 5-13% average annual pricing improvement
- 59% of clients had a PMPM of $125 or less
Better Outcomes
A growing client base and team drive greater value.
- 81 new clients
- 400 plan sponsors, in 42 states, covering more than 1.9 million lives
- New clients added $758 million in pharmacy spend bringing our total spend to $4.3 billion
- Review of high-cost claims by Employers Health clinical pharmacists on a weekly basis
- Improved care for patients with chronic diseases
- Elimination of waste, ensuring appropriate use and excluding high-price, low-value drugs
2024 Employers Health
Book of Business
Data collected in March 2025
In 2024, exciting market developments continued to reshape the prescription drug landscape. These shifts drove meaningful savings across our book of business.
93% of Humira utilizers converted to a low-priced biosimilar
Insulin price reductions saved clients an average of $736.64 at the point-of-sale
Humira biosimilars saved clients an average of $6,675.12 at the point-of-sale
RETAIL NETWORK
Broad
96%Restricted
4%90-DAY NETWORK
Restricted 90-Day (mail plus 1 major chain)
69%Mail and Open
31%SPECIALTY PHARMACY
Exclusive
94%Open
6%SPECIALTY PRIOR AUTHORIZATIONS AND STEP THERAPIES
Yes
98%No
2%NON-SPECIALTY FORMULARY EXCLUSIONS
Yes
94%No
6%NON-SPECIALTY GENERIC STEP THERAPIES
Yes
77%No
23%ADVANCED CLINICAL STRATEGIES
Yes
93%No
7%MEDICAL BENEFIT ONLY DRUG EXCLUSIONS (ZOLGENSMA, ROCTAVIAN, ETC.)
Yes
100%Top 3 Classes
Top 3 Drugs
Top 3 Specialty Drug Classes
Interested In Our Industry-Leading PBM Program?
Complete the form below to learn more about Employers Health, our processes and how our team of PBM experts can save your organization money with the power of employee benefits group purchasing. A member of our team will be in touch soon.