THE PBM Agreement Review (PAR) APPROACH

Phase I – Analysis and Reporting

For a nominal fee, our firm will thoroughly review and analyze the current Agreement with your PBM.
We will also examine and analyze the invoices and reports that they have provided to you.
A detailed report will be prepared, itemizing our findings and estimating the savings that could be achieved through a transparent and pass-through PBM agreement. This analysis includes a comparison of your current rates with those that we know to be available in the marketplace.
This review will also report if the PBM has demonstrated compliance with performance guarantees to which it committed and determine if any resultant penalties were identified and paid. This includes such metrics as adherence to defined pricing rules; guaranteed discounts for generics; drug rebate guarantees; quality of customer service; proportionate share of audit recoveries; and more.

If our Phase 1 analysis identifies a significant savings potential we will propose an engagement under which:

We will contact the present PBM vendor and attempt to renegotiate the existing agreement. (Note that the term of most of these agreements is for an initial three years, followed by successive one year renewals.)
If the PBM will not cooperate, we will recruit a more suitable vendor. Note that, in doing so, we will act only on your behalf. Unlike many other consulting firms, we look only to the Health Plan for compensation.