Sample Findings
What an independent review actually finds.
These are real findings from real employer health plans. Client identities are removed; the numbers are not changed. Each example shows what the plan was told, what the plan actually paid, and what the same drug or service cost outside the arrangement.
Finding 01 — Pharmacy
A “savings” program that cost fifty times the retail price.
An employer with fewer than 70 employees was shown a plan cost of $22,524.74 for one fill of the drug albendazole. A broker offered a “sourcing” program: the same drug obtained for $7,225.30, with $15,299.44 presented as savings — and a 30% fee on that savings charged to the employer.
That prescription was filled three times. Three fills carried a reported plan cost of $67,574.22 and a true cost to the employer of $35,445.39 including the broker’s fees — for a drug available at retail for approximately $200 per fill.
Small employers are often told that problems like this only exist in large plans. This group had fewer than 70 employees — and the arrangement, and the broker’s fee, repeated with every fill.
| PBM reported plan cost | $22,524.74 |
| Broker “sourcing” price | $7,225.30 |
| Claimed “savings” | $15,299.44 |
| Broker fee (30% of claimed savings) | $4,589.83 |
| Employer’s true cost per fill | $11,815.13 |
| True cost for all three fills | $35,445.39 |
| Retail price of the same drug | ≈ $200 |
| Retail for all three fills | ≈ $600 |
What management should take from this: a savings claim is only as honest as the price it is measured against. When the baseline is set by the parties profiting from the arrangement, “savings” and overpayment can be the same transaction — at a company of 6,000 employees or one of 60.
More findings are added as reviews are completed.
Additional examples — claim payments, administrative fees, stop-loss, and vendor compensation — are published here as they are documented and cleared for release.
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