As the pharmacy healthcare industry constantly evolves, it’s important to understand how these changes affect your employee benefits. Specifically, the potential impact for your employees and their dependents as well as you as the plan sponsor concerning operational and financial effects on your overall pharmacy benefits program. Staying ahead of these types of changes can be difficult and sometimes out of your control. What you can do is ensure your pharmacy benefits manager (PBM) contract is market competitive and has the right language to protect you, the customer, and bring more value into your pharmacy benefits program.
Consider this, before you automatically renew your PBM contract, a contractual review is an effective way to determine if your agreement is meeting current market conditions. Adjusting financial, auditable, and business operations components can help identity cost-savings and opportunities for efficiencies to bring more overall value to your pharmacy benefits program for you and your members. Key areas an independent PBM consulting firm can help you review include:
- Pharmacy definitions
- PBM services
- Audit capabilities
- Termination language
- Pricing caveats & guarantees with penalties
- Performance guarantees with penalties
Following a contract review, there may be several financial and operational changes recommended to put you and your membership in the best position for the next benefit year. Of course, identifying areas for improvement is only part of the solution. The more difficult part is what should be included or removed from the contract and what is considered market competitive and reasonable for the new contract terms? Working with a company that’s highly focused on pharmacy benefit programs, and has many years of experience negotiating a variety of PBM-type contracts, could save you 10% or more on your pharmacy benefits program. Having a strong, knowledgeable resource by your side to help you identify the areas of improvement within a contract and then assist in renegotiating those changes could be a game-changer without having to change PBMs.
If you are looking for a full-service company that specializes in contract review and re-negotiation services, reach out to PillarRx at [email protected]. Our company can determine if your contract is meeting market conditions; and if not, how to negotiate better contract rates and terms on your behalf.