Draft & Demand An Entirely Different PBM Contract

Your Plan’s PBM contract is the single, most important document your Plan will execute.

Why? Because your PBM contract controls your Plan’s prescription coverage costs, as well as the services your Plan will receive.

Since it’s virtually certain that your PBM contract is stuffed with loopholes – and missing the provisions necessary to control your Plan’s costs – you need to draft an entirely different contract, and then devise a means to put it into place.

To understand the contract terms you need to draft, read our description of these matters.

To devise a means to put in place your newly-drafted contract, note the following:

If you negotiate one-on-one with your current PBM to obtain entirely different contract terms, it’s very unlikely your PBM will agree to the terms you propose. Why not? Because your PBM is making a lot of money off your current contract, and won’t want to change the contract’s terms. Negotiating one-on-one with a PBM does not provide you with the necessary “leverage” to eliminate contract loopholes and to obtain cutting-edge provisions to control your Plan’s costs.

The best way to obtain the necessary “leverage” to obtain an entirely different PBM contract is to conduct a RFP and require PBMs to win your business by agreeing to the contract terms you demand. This means you need to conduct a contract-focused RFP, not a questionnaire-focused RFP, which is what most consulting firms provide. To understand the difference, read our description of PBM RFPs.

Alternatively, to obtain an entirely different PBM contract, you can investigate joining a Coalition. However, make sure that the Coalition’s contract – like our Coalition’s contract – actually eliminates the omnipresent loopholes that plague virtually all PBM contracts, and actually provides the Coalition with the ongoing ability to control your Plan’s costs.

In short, you can draft and demand a different PBM contract, and you can ensure that you put that contract in place. You just need to take the steps to do so.