CBG adapts to each health plan's culture, population, and goals
A regional, not-for-profit health plan had a clear mission: improve member health outcomes while delivering a pharmacy experience that felt personal, transparent, and aligned with local values. As healthcare costs rose and member needs became more complex, the plan recognized that its traditional pharmacy benefit no longer supported that mission.
Flexibility to Better Serve Members
The health plan wanted greater control over its pharmacy benefit—control that would allow it to prioritize member experience, clinical outcomes, and community relationships rather than rely on one-size-fits-all solutions. They were committed to keeping care local by supporting regional pharmacies and providers that members already knew and trusted. Flexibility and customization were essential to designing benefits that reflected the plan’s unique population and long-term goals.
To achieve this, the health plan partnered with CBG to implement a customized pharmacy benefit model. This approach provided direct visibility into pharmacy utilization and trends, enabling clinical and care management teams to make more informed, proactive decisions. Formularies, programs, and policies were tailored to support medication adherence, chronic condition management, and equitable access to care.
Enhanced Member Experience
Members quickly began to see improvements. Clearer communication, fewer barriers at the pharmacy counter, and locally rooted pharmacy networks helped reduce confusion and frustration. Because programs were designed around the needs of the population, members received more relevant support, including targeted outreach for high-risk conditions and benefit designs that reflect real-world medication use.
Value Aligned With Values
CBG’s customized model aligned seamlessly with the health plan’s people-first philosophy. Rather than focusing on revenue from the pharmacy benefit, the plan reinvested resources into member support, clinical programs, and community partnerships. Local pharmacies became true collaborators in care, strengthening relationships and improving coordination.
As part of this partnership, CBG and the health plan created a Value Preventive Drug List that removes cost sharing for common preventive medications. Available to all members, the list expands beyond Affordable Care Act preventive drug coverage and supports early intervention and long-term health. Covered medications include treatments for mental health, cardiovascular and respiratory conditions, as well as diabetic medications and supplies to help members access essential care without financial barriers.
Today, the health plan views its pharmacy benefit as a strategic asset. With greater control, flexibility, and transparency, it has built a pharmacy experience that strengthens trust, improves outcomes, and stays true to its mission: serving people first.
Savings Reinvested in the Plan
CBG worked closely with this health plan to implement cost-reduction strategies. Together these efforts brought the health plan’s per member drug spending down by 32%
- Improved network contracts
- Channel management
- Clinical interventions and cost avoidance
- Utilization management and formulary strategies
“Members shouldn’t have to decide between paying for their prescriptions or paying their rent.”
