Florida School District Saves $2.1M Through PBM Audit

The Challenge

This K-12 school district had been with the same PBM for seven years without an independent audit. Rising pharmacy costs were consuming an increasing share of their self-funded plan budget, but the district lacked the analytics capability to determine whether their contract terms were competitive.

Our Approach

Med-Vision conducted a comprehensive PBM audit covering 24 months of pharmacy claims data. We analyzed pricing spreads on generic and brand medications, verified rebate pass-through rates against contractual guarantees, and benchmarked the districts pricing against national standards.

Key Findings

• Specialty drug pricing was 23% above market benchmarks
• Generic effective rates exceeded guaranteed maximums on 14% of claims
• Rebate pass-through was only 71% versus the contracted 100%
• Mail-order utilization was below optimal levels due to poor plan design

Results

Armed with Med-Visions analysis, the district renegotiated their PBM contract, recovering $2.1M in overcharges and securing 18% better pricing guarantees going forward. Annual pharmacy spend decreased by $890,000 with no reduction in employee benefits.