By: Kevin Kobielski, President of Navion
In pharmacy benefits, it’s not enough to chase better numbers—you have to understand what drives them. Rebate figures, discount guarantees, admin fees: each can look attractive in isolation. But only by modeling them holistically, against your actual utilization and contract terms, can you see what your PBM deal really means for your organization. That’s why analytics matter more than ever.
A strong pharmacy benefit savings analysis should easily quantify:
- Rebate performance across drug classes and channels
- Unit cost differences, including brand vs. generic mix
- Specialty classification inconsistencies
- Contractual optics (exclusions, definitions, rounding methods)
- Member-level disruption by formulary and drug
Done right, it gives employers a true apples-to-apples comparison across PBM options—not just in dollars, but in risk, experience, and alignment with population needs.
Disruption Modeling: It’s Not Just “How Many”—It’s “Which Ones”
Switching PBMs or updating formulary strategy always comes with change. The question is: what kind?
High-level reports may say “disruption has the potential to be significant.” But that means little unless you know which drugs are affected. Are they lifestyle meds or life-sustaining treatments? Are members likely to tolerate the switch—or face adherence risks? The goal isn’t just to reduce disruption. It’s to manage it thoughtfully—so members get the right therapy at the right cost, without surprise.
Why Prescription Cost-Containment Programs Need to Be Modeled, Too
Pharmacy strategy isn’t just about the core PBM contract anymore. The ability to include third-party cost-containment solutions in your PBM contract is important. A comprehensive pharmacy savings analysis should also show how the addition of key programs could impact the bottom line, including:
- Manufacturer’s Assistance Programs
- International sourcing
- GLP-1 management
- Copay Accumulator Programs
- Clinical programs like step therapy and prior auth
- Integrated cash programs
- Pharmacogenomics
Each of these can significantly change the overall cost equation—and should be incorporated into the model.
For example, one group with 540 self-funded lives and $1.2M in annual pharmacy spend asked us to evaluate their PBM contract and identify cost-saving opportunities.
Their incumbent PBM offered modest savings—about 12%—but lacked access to third-party specialty solutions. By running a full RFP that included their current PBM, we were able to compare all available options and model different strategies.
What stood out: when we prioritized vendors that could integrate specialty solutions and built that into the contract design, total savings rose to 34%. That shift helped the client save $393,000 in just one year, without sacrificing clinical quality or member experience.
When programs are modeled side-by-side, employers don’t have to rely on vendor narratives or gut feel. They can see the economics clearly and choose the path that works best for their unique needs.
This Isn’t About Picking the Cheapest PBM Option—It’s About Picking the Right One
Every PBM says their numbers are better. Every spreadsheet has a bottom line. But unless those numbers are modeled against your population, your trend, and your contract language, they’re just projections.
We’ve seen cases where the lowest-cost option on paper didn’t allow for specialty solutions—limiting long-term savings. Once those programs were factored in with another PBM, the total value far surpassed the original “winner.”
The details matter.
The strongest strategies aren’t built on the best-looking deal. They’re built on clarity. When you model everything, you can manage anything. That kind of insight doesn’t happen by accident—it takes the right team, asking the right questions, and an independent lens to cut through complexity. That’s what gives employers real control—not just over cost, but over care.
