Success Stories - Ochsner Health System
Ochsner Health System is a large hospital employer located in New Orleans, Louisiana with a membership of just over 11,000 (employees and dependents) lives. At the outset, it became clear to Ginger Campbell, BancorpSouth's Insurance pharmacy benefit consultant, that Ochsner Health System's pharmacy program could benefit from plan design changes, more aggressive discounts and a contract guaranteeing discounts from their pharmacy provider.
Once implemented, these changes have since held costs to well under 5%, while other plans have experienced double-digit plan increases. This has been the result of not simply shifting the burden on to members, but rather, offering incentives to members for using lower cost alternatives. Today, the Ochsner Health System pharmacy plan is experiencing a generic fill rate of 60%.
Because the OHS plan, which is administered through their medical carrier, is currently experiencing such a high percentage of generic fill rates, negotiating an aggressive generic discount is equally as important as negotiating brand discounts. Negotiating discounts can be challenging without the help of a pharmacy consultant. Pharmacy providers tend to use industry terms with unclear definitions like "MAC generic discounts". Unraveling the true discount value of these ever-changing terms only adds to the confusion, making it more difficult to negotiate discounts.
As is all too often the norm in the industry, Ochsner Health System did not have a contract with their Carrier that mentioned any pharmacy discounts. Once Ms. Campbell negotiated the discounts, she drafted contract language in a "Letter of Agreement" that guaranteed the discounts, allowed for pharmacy plan audits, and allowed for annual pricing reviews. It is important to include language in multi-year pharmacy contracts to ensure clients get the advantage of the newer price offerings each year.
Controlling pharmacy plan costs is not a one-time effort. To ensure consistent performance, BancorpSouth consultants specialize in pharmacy plan management, proactively monitor the market and negotiate contracts that favor the employer.
