The PBM RFP processes can vary from consultant to consultant, but generally, they include a questionnaire and a financial component as their main areas of focus to evaluate PBM solutions. PillarRx believes there is a third main component that should be included in the process and that is a contract review.

As you know, there is much focus and attention given to the financial evaluation, but we think just as much focus should be on the contract piece as well. Often, the contract piece is reviewed after the RFP process has been completed and the PBM finalist is selected. In this scenario, the client is usually implementing at the same time they are negotiating the contract. We believe that some leverage can be lost at this point and the upper hand is with the PBM. We recommend backing up the contracting process to be included in the RFP evaluation.

Contract Component

By including the contract review process up-front, this allows the client to better determine which financial offering and contractual arrangement most closely meets their needs. In addition, PillarRx can help ensure the contract aligns with the proposal put forth by the PBM. Too many times, we see misalignment from what is provided in the proposal to what is in the contract. Reviewing this up-front helps to eliminate any surprises and allows for the client to ask questions about the contract within the RFP process itself and in essence put the full negotiation power back in the hands of the client.

Contract Evaluation

PillarRx has created an evaluation mechanism for reviewing contracts as part of the RFP process. This strategy allows PillarRx to evaluate contract language and score features of the contract to create more of an apples-to-apples comparison of the PBM solutions being evaluated in the most comprehensive way. This review includes overall administration and capabilities, financials, and contractual obligations/promises. PillarRx focuses on key elements of the contract including definitions, terms and conditions, financials, and other items that require added attention. These determinations are typically based on years of experience with PBM contractual obligations and identifying specific contract clauses and language that may not always be in the best interest of the client.

The PillarRx RFP process is very flexible and is tailored to meet each individual client’s needs. We will be happy to answer any questions you have about the RFP process and all facets of such a project. Click here to contact us today!