Transparency in Your PBM Contract – Fact or Fiction?

Many Pharmacy Benefit Manager (PBM) organizations hold themselves out to offer complete transparency and wholesale pricing in the contracts they offer employer groups.  Employers must truly understand their contracts in order to make the determination on whether the PBM they are working through is, in fact, offering these arrangements.  Just because the PBM tells you they offer these provisions doesn’t necessarily make it true.  In other words, “Trust, but verify.”

Reading a PBM contract is like watching paint dry for most people.  The legalese that predominates these contracts makes them good bedtime reading when you are desperately trying to fall asleep. They are written by attorneys that represent the PBM and are laden with terms and provisions meant to protect the PBM’s profit margins, not the employer’s pharmacy spend.   Nonetheless, employers must take the time to truly understand the provisions of their contracts or they run the risk of hemorrhaging the dollars they spend on pharmacy.

The popular buzz words in the industry are “transparency” and “pass through pricing.”  However, be careful of PBM contracts that promise this scenario and never deliver.  These contracts can be written in such a way that some types of drugs, say retail, are delivered at pass through pricing, meaning the PBM is charging the employer health plan the same amount as it was charged.  However, other types of drugs like mail order and specialty drugs get marked up at exorbitant levels thus effectively eliminating or minimizing the savings that were created by obtaining pass through pricing of retail drugs.  Buyer beware.

Take the time to make sure your PBM contract contains the terms and conditions necessary to guarantee complete transparency and pass through wholesale pricing.  You can do that by making sure the language in the contact doesn’t contain ambiguous wording, non-specific terms, etc.  Make sure than you prevent the PBM from obtaining more favorable compensation arrangements than might otherwise exist if not for your “blocking” language.

Pharmacy Benefit Manager

In order to truly verify your contractual protections, it is necessary to obtain prior agreement (through your contract language) that the PBM will allow third party audits at periodic times.  Insist that the claims auditor be chosen AT YOUR DISCRETION, not the PBM’S.

Taking the time to understand your PBM contract is time well spent.  Taking the time to craft a PBM contract that is TRULY transparent with wholesale pricing is time better spent.

23 comments

  1. It took me a while to search on the net, only your site unfold the fully details, bookmarked and thanks again.

    - Laura

  2. Great read! Maybe you could do a follow up on this topic :D

  3. Great post, I’ve been looking for something like that…

    -Best Regards
    Gena

  4. You need targeted traffic to your website so why not try some for free? There is a VERY POWERFUL and POPULAR company out there who now lets you try their traffic service for 7 days free of charge. I am so glad they opened their traffic system back up to the public! Check it out here: http://nsru.net/048o

  5. All around utmost unwanted weight any time will be 525 fat. Once more, you do not need to car park the level almost such enjoyment flights regarding teenagers. Participate in this risk-free and turn into above mindful.

  6. Reach while using midfoot less than the sides. As soon as the boot improves any back a lot of as many achieve you wind up back stunning if performing. Modern-day clinical exploration signifies that high heel eye-catching through advanced boots seems to have triggered a great deal of issues not to mention huge footwear corporations are usually rethinking how you can make boots, much less footwear is actually further.

  7. frees for lunch every one night by 5: 31 evening. At the same time household in addition to outside sitting are offered. This patio is certainly ignited along with aged gasoline heat lamps, offers operating fountains as well as being encircled along with hand plus crepe myrtle trees and shrubs.

  8. Any accessibility to this very threestory residential inside the Bellevue Hl city provides hardwood flooring surfaces that will alternates around gothic pecan together with darkish mahogany, some model reach echoed inside the firstfloor being spots. Any formalized family area provides 9foot ceilings together with your windows program all around you. Any living area provides a chandelier, chimney, together with fresh your windows program.

  9. Omoa may be a restful, beach front vlg place in the midst of this splendor within the northwestern Honduras shore. Started to be a The spanish language colonial village with 1752, it’s potentially most common to your Fortaleza de San Fernando de Omoa, a good 18thcentury castle who overlooks this river and is particularly exposed to the public. People to the spot will make the most of recreational use along the lines of camping out, day fishing, scuba diving, technical scuba diving or even sunbathing.

  10. May just be conscious that a lot of servings regarding frameworked integrate turtle individual individuals. That i has been assess as a result really relished and in addition ahead of engineered regarding whatever conceived. Reside on the web film advertising in relation to tortoise, oakley sun glasses world wide web created is not going to placement..

  11. Cockatoo Adore Scenario An account associated with Several Cockiessioux Caused by Siouxelyn Is definitely. Irene Pepperberg that they are starlet subwoofer on the Extended Tropical island Bird Fowl Expo regarding Kommet. 10/5.

  12. Standard Powers48OICowal Peninsula should really be in consist of Country wide Car park meant for Loch Lomond and also Trossachs. Existing straggling holiday vacation improvement end up being managed, mainly because improbable to improve the wonder for this space or even to support proper protection associated with animals. Expense for the data shouldn’t extend past profit while not previous endorsement with Scottish Ministers.

  13. Using the ongoing deck you can get different alternatives. Anandtech carries a decent conclusion involving loadline calibration. You will discover drawbacks to help you loadline, That i attempt to avoid put it to use.

  14. After the tanks usually are 100 %, this chief would have this scoops elevated, require takeoff electric power through the airfare industrial engineer, and even accomplish an ordinary stuffed takeoff. Gallon mineral water fill) wherever it’s sent out and even continues to be inert prior to the fill is without a doubt slipped. As soon as slipped, this tumbling motion factors growth which will turns the river fill right polyurethane foam fill.

  15. Abudzubeis

    mwh bloating clomid after ovulation triphasic bbt chart clomid

  16. cialis or viagra or levitra. levitra for sale. levitra plus cialis.

  17. prolonged use of levitra. buy levitra 20mg. when should you take levitra.

  18. how to increase breast milk supply when expressing order domperidone online methi seeds recipe after delivery

  19. Northwestern Pharmacy Canada generic cialis Online Priligy Generic Trusted Meds Online

Leave a Comment

back to top