On Point with Navion, Episode 1
When an employer considers moving from a fully insured health plan to self-funding, much of the conversation centers on claims risk, stop-loss coverage and plan design.
But one of the most important financial questions is often left in the background: What’s happening inside the pharmacy benefit?
In this episode of On Point with Navion, Lad Williamson explains why pharmacy should be evaluated before a group changes funding arrangements, and why becoming self-funded doesn’t automatically mean the plan will begin capturing every available savings opportunity.
What Brokers and Employers Need to Know
A fully insured arrangement may offer predictability, but it often provides limited visibility into the factors driving prescription drug costs. When a group becomes self-funded, more information and more options may become available.
That creates opportunity, but only when the pharmacy benefit is actively evaluated and managed.
Three important takeaways from the episode:
- Pharmacy should be part of the funding conversation. A group needs to understand its pharmacy exposure before deciding whether self-funding is the right move.
- More visibility doesn’t automatically create better results. Data is only valuable when someone can interpret it and determine what it means for the plan.
- Selecting a PBM isn’t the end of the strategy. Groups still need an independent perspective focused on whether the arrangement is delivering the expected value.
Is Your Group Missing Pharmacy Savings?
Whether a client is fully insured, level-funded or self-funded, brokers should ask:
What could this group be missing by not taking an unbiased look at its current pharmacy spend?
The answer may affect not only the pharmacy strategy, but the group’s broader renewal and funding decisions.
For a deeper look at the issue, read Lad’s article, “Your Groups Are Overpaying on Pharmacy. The Renewal Math Is Hiding It.”
Ready to evaluate a specific group? Request an Rx Savings Analysis
