Flexible Pricing Model Helps Health Plan Drive Savings

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CLIENT PROFILE
  • 600,000
    Life Health Plan
  • 120,000
    Self-funded Lives​
WHAT WE DID
  • Assess and develop a comprehensive pricing model
  • Developed group-level P&L structure
RESULTS
$20.0M Increase in Rx Margins
Heading Style

AlignRx partnered with this regional healthcare provider to address client retention issues and increasing market pressure to develop a more flexible pricing model. Our pharmacy consultants performed a comprehensive assessment of the current pricing model to develop the design of a new, comprehensive three-tiered pricing model. Our team also helped to ensure the new model’s success by facilitating the implementation of this new structure throughout their book of business.

The new model created enhanced revenue streams by fielding a larger diversity of lower-yielding rebates and implementing third-party programs throughout. In addition, we reduced potential financial exposure through the modification of the group contract language.

Utilizing our proprietary ASORx 360 solution to navigate the self-funded medical prescription landscape, we were able to increase the retention rates of current clients while also increasing the membership sector by carving in previously carved-out clients. AlignRx empowered the provider to become more competitive by optimizing the performance of their pharmacy business. We provided ongoing market support for the pharmacy team and created tailored solutions to address their key revenue gaps in multiple areas throughout the entire process. The result was an exceptional increase in annual profitability of $20 million dollars.

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