Summary
Quest Analytics Group partnered with a financial services firm with 3,500 members and $5 million in pharmacy spend in 2023. Through a detailed claim-level analysis and a comprehensive RFP process, we delivered $2.67 million in actual savings—far exceeding the initial projection of $865,000 and the RFP’s guaranteed savings of $1.37 million.
Problem
The firm, which specializes in short-term loans, credit insurance, and ancillary insurance products, needed to optimize its pharmacy benefits program for a geographically dispersed workforce—while maintaining consistent drug availability and network access. Minimizing member disruption was a critical priority.
Our no-fee benchmarking analysis uncovered several key issues:
- Incorrect drug categorization affecting both pricing and rebates
- Ineffective clinical management, even though it was outsourced to a third-party vendor
- Rebate qualification terms that were outdated and misaligned with current market norms
- Limited distribution drugs excluded from rebate eligibility
- Hidden administrative costs, including broker and rebate processing fees
Based on these findings, we estimated the client was overspending by approximately $865,000 per year.
Solution
To address the identified gaps, Quest launched a formal RFP process. We invited five PBMs to submit proposals: the incumbent, two large PBMs, and three mid-market providers.
Our RFP was strategically designed to include ongoing oversight requirements:
- Annual audits to verify contract compliance and sustain savings
- Quarterly pricing reviews to catch and prevent future issues
- Medical benefit oversight for speciality drug selection and site of care
- Mandatory absorption of all consultant and broker fees by the selected PBM
Throughout the process, both the client and their broker jointly maintained decision-making authority in evaluating proposals and selecting the final provider.
Success
Our work delivered exceptional outcomes for the financial services firm:
- Generated $2.67 million in actual savings—far exceeding both the $865,000 estimated during benchmarking and the RFP’s guaranteed savings of $1.37 million
- Moved out of a national PBM consortium and into a direct relationship with the same PBM to preserve continuity for members
- Preserved the formulary to ensure minimal member disruption
- Shifted all consultant and broker fees to the PBM, eliminating direct costs to the client
- Reduced pharmacy costs by 53.4% compared to the original spend
- Extended the same favorable contract terms to a newly acquired division, delivering additional savings
This case illustrates Quest’s ability to uncover hidden inefficiencies, generate competition, and secure market-leading results—without compromising on member experience or operational consistency.