Signing a contract with a trustworthy pharmacy benefit management (PBM) organization is not easy. It requires more than just knowing the changing rate of prescription drugs and how it affects demand and inflation. There are other factors that affect the partnership.
As someone looking for the best PBM deal, remember these strategic evaluation considerations.
Transparency is the name of the game—full transparency to be exact. This should be the norm in business transactions. You have the right to know everything from top to bottom. It is a must for you to have full auditing rights.
Ask for an open declaration of all relevant matters that will appear in the contract. This includes full pass-through pricing for instate and out-of-state pharmacies, contracted and effective rates for both branded and generic agents, and full auditing privileges to PBM acquisition expenses and group pharmacy deals.
Know pricing agreement related to anticipated effective rates as well. Inquire about references on the average wholesale price for reimbursements and processed claims.
Maximum Allowable Cost (MAC) Concerns
As it is in contract bargaining, be fully knowledgeable of MAC pricing. Ask for full access to the PBM’s MAC lists with corresponding policy terms, standards, and descriptions.
Companies offering PBM contract consulting like Crystalclearrx.com recommend a full disclosure agreement on any contract between PBM and drug manufacturers that may concern rebate earnings, drug rate data, and manufacturer profits.
Let the PBM reveal all their cards on the table. Know their plans on mail-order pharmacy service program from detailed pricing information, benefit design, and pricing model. Ask for a disclosure of all fees.
Access to Claims Records
Make sure that you will have full online access to claims information from prescription deals to sales proceeds.
Consultants of Choice
Go over the consulting firm’s services. Know their experience and expertise. Ask for an assessment of your plan’s PBM deal to reveal benefits and possible conflicts of interest.
There are important considerations before signing a contract with a PBM. Make sure to look at everything that matters so that you will not regret your decision.