Point C takes a more dedicated approach to pharmacy cost containment. We look at what is driving costs, where the current PBM (Pharmacy Benefits Manager) may be falling short, and how targeted changes can improve plan value.
Point C is URAC-accredited for Pharmacy Benefits Manager (PBM) services, bringing a disciplined review process to how pharmacy benefits are priced, contracted, and managed.
A detailed review of PBM contract terms, pricing structure, rebate treatment, specialty provisions, and renewal conditions.
A PBM savings analysis based on market data to help employers compare current performance against available opportunities.
Support in negotiating better rates, stronger terms, and more affordable options for the plan.
Focused review of high-cost specialty medications to identify additional savings opportunities through sourcing, site-of-care, or clinical review.
10%
average savings on pharmacy spend after rebates
When a member is diagnosed with a serious or ongoing health condition, the financial impact on the plan can rise fast. Care Management helps employers and brokers address two priorities at the same time: member outcomes and plan performance.
A small number of high-cost therapies can account for a large share of total spend, especially when specialty drugs, contract terms, and sourcing decisions are left largely unchecked.
That is why pharmacy trend often looks disproportionate to overall utilization.
Specialty medications with high recurring cost
Site-of-care and sourcing decisions that are not optimized
PBM pricing models that limit visibility into margin
Weak oversight of high-cost therapies
Rebate arrangements that are difficult to evaluate
A meaningful PBM review should go beyond discount guarantees and headline rebates to answer the questions employers need answered before renewal or market review.
Point C reviews pharmacy through the lens of total plan performance.
Limited to renewal terms or standard benchmarking
May remain embedded in the arrangement
Partial visibility into retained revenue
Not always explored
Standard utilization management
Broad utilization summaries
Incremental renewal changes
Detailed review of pricing terms, rebate treatment, and specialty provisions
Evaluated directly as part of PBM review
Pass-through structure and total economics reviewed side by side
Considered for eligible high-cost specialty claims
Added review of medical necessity, dose, and high-cost therapy performance
Actionable reporting for vendor and plan decisions
Broader pharmacy cost containment strategy tied to plan spend
