BG Analytics


Plan Analytics


Client had employees going to outside providers and company not qualifying for 340B reimbursement

...analyzed pharmacy claims and worked with in house pharmacy to provide second tier of Rx coverage outside of PBM and changed plan design and education to drive specialty drug scripts to in house providers!

case study 4


Met with HR and Management on pharmacy pricing and 340B reimbursement. Ran claims data from TPA through our Decision Master Warehouse (DMW) claims tool to see how claims stacked up against benchmarks.


Claims data showed higher utilization in certain services. Specialty medications were getting 340B reimbursement for those seen by in-house providers running through in-house pharmacy. Some specialty medications being paid at PBM pricing.


Changed copay on ER services to bring utilization down. Lowered copays for in-house providers that are prescribing specialty medications and increase spread for medication cost by $250 to drive as much specialty usage through 340B program. 

New Copay for In-house visit for specialty med

Cost difference between in-house specialty fulfillment and national pharmacy

New cost difference between urgent care and emergency room



Overhauled communication materials

Altered plan design based on data analysis

Educated employees with group meetings on changes

Provided digital means of education for those who could not attend

© 2018 Clarke & Company Benefits LLC

connect with us