From $750K Shock to 0% Renewal
The Challenge
A single dependent’s specialty medication priced at approximately $750,000 per year accounted for more than half of the plan’s annual spend. For the second consecutive year, the carrier signaled a 25%+ increase—an unsustainable path that threatened deep benefit reductions or compensation tradeoffs. The employer needed a solution that protected the family, stabilized costs, and preserved the broader workforce’s plan design.
The IMPACT
By removing the catastrophic exposure from the plan, the incumbent carrier reduced premiums by over $250,000 and the employer’s net renewal dropped to 0%, reversing the projected 25%+ hike. The family paid $0 for the life-saving therapy and saved more than $8,000 in annual out-of-pocket costs. The employer maintained its existing plan design, safeguarding morale and retention, and a likely 50% cumulative two-year increase was averted.
The Strategy
JA conducted a deep claims analysis to isolate the true cost driver and matched it to a third-party alternative coverage program designed for the specific therapy and related clinical services. We coordinated enrollment so the child received $0 premiums, $0 deductibles, and $0 cost sharing while continuing care with the established provider team—ensuring a seamless, disruption-free transition. In parallel, we negotiated with the incumbent to reflect the risk removal in premiums and established ongoing oversight to monitor clinical continuity and member experience.
THE OUtcome
Premium impact: $250,000+ annual reduction tied directly to targeted risk transfer; employer net renewal at 0%.
Trend averted: 25%+ in-year increase avoided; 50% cumulative two-year escalation likely avoided.
Member experience: $0 premiums, deductibles, and cost sharing for the therapy; $8,000+ annual out-of-pocket savings; uninterrupted access to the established care team.
Plan stability: No plan design takeaways, preserving competitiveness in talent attraction and retention.
Things Employers Should Consider
Which single high-cost drivers are distorting your renewal, and can a targeted risk transfer neutralize them without degrading benefits? Start early—well ahead of open enrollment—to align carriers, contracting, and member advocacy for a seamless transition. Measure success on both axes: hard-dollar savings and a dignified, disruption-free member experience.