Gateway Business Health Coalition (BHC), who runs a PBM coalition representing 43 employer groups and 300,000 covered lives, recognized that its PBM contract left its member employers with limited visibility and little leverage. BHC built a structured, coalition-driven competitive evaluation process. Partnering with Foundational Pharmacy Strategies (now part of MacroHealth), BHC designed and executed a rigorous process that analyzed employer's actual claims data against transparent and traditional PBM models. The results were concrete: the coalition formally selected a preferred transparent PBM partner estimated to save members 25% on overall pharmacy cost, and added a specialty pharmacy benefit option estimated to reduce specialty drug spend by 40%, both announced in early 2026.
This session tells that story in full and gives attendees a blueprint to replicate it.
Attendees will leave with:
A replicable framework for running a coalition-driven PBM evaluation, including how to structure vendor participation, scoring, and employer education
An understanding of how to evaluate true net cost vs. contractual guarantees.
Real financial results from the BHC employer claims data analysis, including 25–41% reductions in specialty drug spend for participating employers
A blueprint for using CAA fiduciary obligations and claims data ownership rights to demand greater accountability from PBM partners
Guidance on how to engage transparent and specialty PBM vendors and what questions to ask