The Pharmacy Benefit Management industry is complex by design and has a “Catch me if you can” environment.

The PillarRx team will be the first to tell you, that no matter which PBM partner you have and decide to move forward with, “Trust but verify”.

Sometimes PBMs will offer fantastic pricing rates as part of the sales process, even though they will not be able to meet those guarantees. They do this because they know most clients will never audit them directly or the contract is written in such a way that limits the client’s auditing capabilities. There are many employers and health plan sponsors that choose a PBM partner and then never monitor or audit over the life of the contract.

Even the best PBMs occasionally make a mistake. We have found that it is much better to identify those issues as soon as possible, so the issue can be corrected, the exposure minimized, and a remediation plan executed.

Ongoing PBM monitoring is a smart business investment and it helps protect any exposure to your pharmacy benefit program. As the fiduciary of the plan benefit, it is ultimately the responsibility of the plan sponsor to protect their program dollars and no one should be as motivated to do that as you!

Relying on the PBMs to self-audit is like allowing the “fox to watch the hen-house.” In the end, you can have the most reputable PBM working for you, but it is best practice to protect your program through ongoing monitoring and auditing.

Have questions? Leave a comment or contact one of our experts at PillarRx!