Your Checklist to Ensure a Transparent PBM Contract
Contract transparency is crucial for building trust and efficiency between a Pharmacy Benefit Manager (PBM) and its partners. This checklist provides a vital tool for all stakeholders to ensure clear and fair PBM agreements. From defining contract terms to transparent fee structures, we build easy-to-understand contracts. Following this checklist can strengthen relationships with your clients, avoid issues, and maintain integrity and transparency in PBM dealings.
✔ Clearly define all contract terms
Ensure clear definitions for all contract items, including brand and generic drugs, to avoid ambiguity in defining terms like ‘brand’ and ‘generic,’ which could impact pricing and rebate eligibility without contract qualifiers.
✔ Transparent fees
Transparent fees, including services and potential additional charges, should be explicitly outlined in the contract to prevent hidden fees or manipulative pricing strategies from unexpectedly inflating costs.
✔ Data access
Clients should have full access to their data, including detailed claims files, to analyze and own it for informed decision-making.
✔ Audit reports
A provision should grant audit rights to both parties in the contract to ensure compliance and accountability to the contract terms.
✔ No spread pricing
The contract should include pass-through pricing, which charges plan sponsors the amount paid to the pharmacy without any markup. 100% of discounts, rebates, and incentives are passed directly to the plan sponsor.
✔ Rebate Reconciliation
Ensure rebates are reconciled regularly and that excess rebates are paid to the plan sponsor.
By checking for these six items, you and your clients can rest assured that you’re getting a transparent PBM contract.
To learn more on how we provide transparency in PBM partnerships, check out our related blog:
What Does It Mean to be a Transparent PBM Partner?
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 36 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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