Below are some of the highest value savings we uncovered in 2025.

1. An employer was part of a large GPO coalition PBM benefits plan and able to access significantly better discounts and contractual terms as compared to employers outside the GPO coalition. Upon changing GPOs to reduce overhead costs, the employer was told the new GPO did not have a coalition PBM plan and would need to seek a new PBM benefit plan on their own. We re-engaged the original PBM and found the employer could join their HR Benefits GPO only and thereby remain in the coalition. New RFP resulted in guaranteed $12.5M savings compared to previous agreement

2. As a result of forensic rebate analysis, we determined that an employer was having GLP-1 rebates clawed back by Novo Nordisk due to a class of trade issue. Although there was no specific clause in the contract that allowed for such a clawback, Novo would not move. After weighing the pros and cons, we advised the employer how a change in class of trade to capture rebates would benefit them financially.

   Annual savings $6.5M

3. During 2025, two blockbuster specialty drugs, Humira and Stelara became available as biosimilars. An employers coalition recommended using the biosimilar from the PBM-owned manufacturer and retaining rebates. We analyzed other options and found that other available interchangeable biosimilars would save our client over $8M annually, but did not have rebates. The employer accepted our strategy, modified the PBM formulary, gave up chasing the rebates and pocketed the savings in 2025.

4. We uncovered that an employers PBM was paying claims for a drug called Emverm. Pharmacies were allowed to dispense and bill 30 tablets for 30 days supply when the manufacturer only allowed 2 pills per month. Recommended changing Utilization Management for Emverm which was adopted, saving $500,000 annually

5. We uncovered a new trend of some retail pharmacies dispensing a drug called "Surebiotic" at over $1300 per 30 days. This agent was not much more than a presciption version of the OTC probiotic, acidophilus. We notified the clients PBM and removed from the client formulary immediately. The PBM eventually removed from their larger formulary after review by their P&T Committee.

6. In December 2025, our clients consultants conducted a market check and agreed to remove 36 drugs from the specialty tier. However, our client received significant guaranteed minimum rebates for those specialty tier claims. The client also had their own pharmacies and minimal specialty copays. Our analysis showed a negative financial impact of over $5.5M annually. We negotiated an alternative solution with the PBM and saved $5.5M