Problem

A broker approached Sola Health with a small group already in a level-funded plan with a BUCA carrier. However, the group faced an escalating issue with high-cost claims, primarily centered on specialty pharmacy costs.

Two employees' medications were driving claim costs to untenable heights:

• Medication 1: $160,000 annually ($11,900 monthly)

• Medication 2: $142,000 annually ($11,833 monthly)

The employer was shouldering these costs in full, greatly impacting their bottom line.

Solution

Sola Health conducted a thorough analysis and discovered that the existing carrier had restricted access to more affordable specialty pharmacies, leading to a 600% markup on the drugs compared to the market average.

Results

Leveraging our deep pharmacy expertise, we recommended a series of cost containment solutions to the group including new PBM procurement and domestic fill and medication assistance programs. By leveraging our solutions, the group would save up to $140,000 annually on medication 1 and up to $108,232 on medication 2 – a combined savings of nearly $250,000.