PBM Consulting

Substantially reducing pharmacy benefit costs without sacrificing plan quality.

Specialty Drug Management

Managing one of the largest hidden costs of medical care.

Government Programs

Navigating the complex marketplace of Medicare, Medicaid and Exchanges.

HEALTH PLANS

Providing strategic solutions to regional and national health plan partners.

HOSPITALS AND HEALTH SYSTEMS

Offering national expertise and local market insight in the ever-changing healthcare landscape.

ABOUT US

Excelsior Solutions is your cutting-edge expert with the resources to manage your pharmacy program effectively, contain cost, and be accountable for the results. 

We are the next generation of consulting. We are the solution.

Excelsior Solutions is a fair and impartial mediator between employers, health plans, health systems, TPAs and their PBM firms.

We help clients:

  • Optimize the PBM marketplace
  • Leverage improved PBM and vendor arrangements
  • Identify additional opportunities for cost savings
  • Develop sound strategies that will keep pace with the dynamic marketplace

We specialize in creating and managing:

  • Customized medication management solutions
  • Outpatient PBM programs
  • Medical pharmacy (physician-administered) medication solutions
  • Health plan PBM vendors
  • Hospital and health system pharmacy benefits, including 340B consulting
  • Self-funded employer PBMs

INDUSTRY NEWS AND INSIGHTS

Newsletters

ICER Updates

Case Studies

EMPLOYER PHARMACY RECONCILIATION

BACKGROUND 10,000 employees $21.5 million in annual drug spend SOLUTION Excelsior Solutions performed annual reconciliation in first year

Health Plan
Reconciliation

BACKGROUND Midwestern health plan 37,000 members $70 million in annual drug spend SOLUTION Annual claims reconciliation revealed incorrect classification of

Opioid Alternative

BACKGROUND Member was filling opioid prescription at $16,000 per month Excelsior Solutions evaluated options to determine best treatment for member SOLUTION Service team initiated conversations with member’s

Contact Us

Services

Company

Excelsior Solutions

5500 Wayzata Boulevard
Suite 510
Minneapolis, MN 55416
763.512.8600

Employer Pharmacy Reconciliation

BACKGROUND

  • 10,000 employees
  • $21.5 million in annual drug spend

SOLUTION

  • Excelsior Solutions performed annual reconciliation in first year to confirm PBM met all contractual obligations
  • Pharmacy experts identified $240,000 contract performance shortfall
  • Reconciliation process revealed $500,000 in paid compound claims

RESULT

  • In first year, client saved $6.8 million (19%)
  • Client saved 21% with new PBM over a three-year period
$6.8 Million in Savings
Health Plan Pharmacy Reconciliation

BACKGROUND

  • Midwestern health plan
  • 37,000 members
  • $70 million in annual drug spend


SOLUTION

  • Annual claims reconciliation revealed incorrect classification of single source generics (SSGs)
  • Contract stated SSGs would be included in generic guarantee
  • PBM excluded SSGs from reconciliation

RESULT

  • Client refunded $1.17 million for underperformance of generic guarantees
Client Refunded $1.17 Million
Opioid Alternative

BACKGROUND

  • Member was filling opioid prescription at $16,000 per month
  • Excelsior Solutions evaluated options to determine best treatment for member

SOLUTION

  • Service team initiated conversations with member’s provider and carrier to discuss alternative treatments
  • Provider agreed that opioids were not necessary for proper treatment
  • Prescription was withheld and member was provided with detox therapy for opioid addiction

RESULT

  • Eliminated unnecessary cost to client
  • Annual savings of $192,000
Annual Savings of $192,000