Challenge

A national health insurance carrier engaged Patina to support a strategic redesign, improvement in cost of goods sold (COGS), create operational efficiencies, and enhance reporting and analytics, as well as support the implementation of its pharmacy benefit manager (PBM) strategy. The carrier was seeking senior executives with proven, deep industry experience in developing and launching this approach in a national multi-line carrier environment.

Solution

This multi-year engagement has included an assessment of current operations and financial performance of all pharmacy programs, services, and vendors. Patina assisted with the development a five-year strategic plan to redesign and implement PBM operations including financial modelling, technology assessment and transformation, underwriting, organization structure design, contracting strategy, and operations integration and management.

Outcomes

The engagement is in its implementation phase and projected to significantly improve the competitive position and financial performance in all aspects of PBM operations. The project is on course to produce a multi-million dollar bottom line improvement, with a minimum of a 100:1 return on investment.