Client Profile
Large Self-Funded Employer Group (3,000+ Lives) and Third-Party Administrator (TPA).The Problem
The client’s pharmacy benefit plan was facing unsustainable volatility due to specialty drug inflation and a "Black Box" PBM model that obscured true acquisition costs. The goal was to establish targeted intervention on the top 10% of high-cost claims and eliminate plan leakage without reducing member access to care.
Strategy Yielded $61.7M in Realized Savings
Deterministic Procurement.
CLIP deployed its Integrated Cost Containment Engine by layering four distinct, fully auditable savings channels across the entire claims base. This strategy eliminated hidden costs at every level and secured the lowest verifiable acquisition price for all targeted medications.
Pillar 1
Global Sourcing
Solutions
(25% – 60% Savings)
CLIP targets the largest portion of specialty spend by sourcing high-cost brand biologics through licensed, Tier-1 international pharmacy networks.
Pillar 2
Upfront Manufacturer
Assistance
(15% – 40% Savings)
CLIP applies manufacturer assistance and statutory discounts directly at the point of sale. By anchoring to actual acquisition costs, we eliminate rebate lag and traditional float for both the plan and the member.
Pillar 3
Generic Contract
Pricing
(10% – 30% Savings)
CLIP utilizes direct contracts and Group Purchasing Organizations (GPOs) to eliminate PBM spread and secure best-in-market acquisition pricing for generics.
Pillar 4
Statutory Discount
Pricing
(25%-60% Savings)
CLIP manages the compliant end-to-end Statutory Pricing workflow for eligible high-cost claims, maximizing federal discounts while ensuring 100% auditable transaction traceability.
Key Findings
Fiduciary-Verified
Performance
Savings by Therapeutic Category
This breakdown directly addresses the client's largest cost drivers, showing
how savings were successfully focused on high-trend specialty groups.
without authorization for identification purposes only. CLIP Benefits is not affiliated with these manufacturers."
Comparative Analysis:
Deterministic Sourcing vs. Traditional PBM Benchmarks
without authorization for identification purposes only. CLIP Benefits is not affiliated with, or endorsed by, these
manufacturers. Savings are achieved through procurement efficiency and deterministic net pricing models."
Conclusion
CLIP's model identifies significant net savings across applicable claims,
successfully stabilizing the specialty drug trend through deterministic procurement
while maintaining clinical quality.
"Modeled savings reflect identified avoidable plan leakage on high-cost claims routed to CLIP pathways;
actual results depend on voluntary member participation and channel permissions."
Guaranteed Price and
Transparency
By shifting fulfillment to channels
governed by Guaranteed Net Pricing
(GNP), the client gained auditable,
predictable costs, eliminating reliance
on delayed and often ambiguous
rebate checks.
Operational
Excellence
The Enterprise HUB Package proved
essential, leveraging omnichannel
communication and pharmacist-led
oversight to maintain over 90%
member adherence throughout the
conversion process.
Strategic
Alignment
CLIP's solution is designed to
surgically enhance the pharmacy
benefit where traditional PBM models
fail, focusing on acquisiton-cost
transparency across the most volatile
specialty and chronic drug classes.
This strengthens the fiduciary position
of the plan sponsor and creates
sustainable, long-term trend control.