The Challenge

The Client, one of Saudi Arabia’s largest GCC insurance providers, faced an escalating challenge in managing pharmaceutical expenditures – accounting for nearly 40% of total medical costs.

 With rising demand for innovative and high-cost medications, the situation risked undermining financial sustainability and competitive positioning.

To address the Client asked Emica to help them operationalize a comprehensive formulary, rebate, and contracting framework to contain costs while maintaining quality of care.

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Our Approach

• Conducted a full diagnostic assessment of existing pharmacy expenditure, formulary structures, and contract processes.
• Benchmarked international and regional best practices in formulary design, rebate structures, and negotiation frameworks.
• Designed a comprehensive multi-phase strategy encompassing formulary governance, rebate negotiation SOPs, and contracting templates.
• Developed end-to-end workflows, monitoring dashboards, and reporting tools to track rebate performance and compliance.
• Delivered extensive training and knowledge transfer sessions to procurement, operations, and legal teams to embed new capabilities.

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Outcomes

• Achieved measurable cost reductions of 0.6–1.2% in diabetes management costs through structured rebate negotiations.
• Implemented a new formulary framework contributing to an overall 1% reduction in total diabetes-related expenditure.
• Established and institutionalized a Pharmacy & Therapeutics (P&T) Committee for sustainable formulary governance.
• Strengthened internal capabilities and cross-departmental alignment for long-term cost containment and strategic sourcing.