A Recipe for a Transparent PBM Relationship 

Measuring cups and measuring spoons filled with ingredients and medications along with a prescription pill bottle alluding to the title of the blog - Ingredients for a Transparent PBM relationship

A critical recipe to master rising drug costs involves creating transparency with your pharmacy benefit manager. Like baking, it takes the right ingredients, prepared and combined thoughtfully, to yield the best outcome for PBM transparency in partnerships. Follow this recipe to ensure you can see clearly into your PBM partnership

Ingredients: 

  • 1 cup of Defined Contract Terms 
  • 2 cups Ownership of Complete Claims Data 
  • 3 tablespoons Insight into Revenue Sources 
  • 1/2 cup Understanding of Price Components 
  • 1/4 cup drug-by-drug rebate reporting
  • 1 pinch of Performance Metrics 

Instructions: 

  1. Carefully review all definitions in your PBM contract to confirm clarity on key terms related to drugs, fees, rebates, spread, and more. Undefined gray areas can hide profits. 
  2. Require full ownership and timely access to complete claims data records. Without knowing exactly what was paid/received on every prescription, you’re baking blindly. 
  3. Ask your PBM to disclose all revenue streams they receive from your plan, manufacturers, pharmacies, etc. Opaque admin fees and retained rebates leave you guessing. 
  4. Insist on visibility into the price building blocks for every prescription, from net ingredient cost to fees applied – down to the final cost. Mystery ingredients drive up spend.
  5. Establish clear metrics tied to guarantees on costs and service levels. This allows you to assess performance. 
  6. Access detailed rebate distribution reports with drug-by-drug details for in-demand insights on rebate reconciliations.

With the right pragmatic ingredients prepared properly, you can achieve full PBM transparency. That insight is essential to confirm your pharmacy benefits are optimized. Monitor closely and continually taste-test the partnership mix. Active involvement prevents any hidden surprises from rising. 


About Serve You Rx   
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for over 37 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.


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