PRM RISK ASSESSMENT
Determine Current PBM Risk Factors with Three Simple Assessments
The role of human resources in managing prescription drug benefits has never been more crucial. Recent high-profile lawsuits have underscored the importance of proactive and informed oversight of pharmacy benefits.
Compare Your Top Drugs
Is your PBM actually providing your employees with fairly priced medications and optimizing for low out-of-pocket costs? Are they ensuring the lowest net cost for you as the plan sponsor? Complete your own top drug analysis now.
Assessment Two
Calculate Your PMPM
What are your per member per month costs including admin fees, ancillary fees, and drug costs? Find out using this simple calculator.
Assessment Three
Understand Your PBM Evaluation Process and Contract
The current RFP process for PBMs obfuscates real costs by overly focusing on discounts. If you answer “yes” to any of the questions, your evaluation process may be flawed.
Did you pay separately for the RFP process or was it subsidized?
Why does this matter?
Beware of "free" RFP offers from pharmacy consultants. These costs (up to $7 PMPM) are often built into the PBM's spread pricing, leading to higher drug costs. What seems free upfront ultimately increases your pharmacy spend.
Is your PBM involved in financial relationships with brokers or consultants?
Why does this matter?
PBMs that have financial arrangements with brokers or consultants can create conflicts of interest. These hidden payments, often passed onto the client, may lead to higher overall costs and reduced transparency in how your plan is managed.
Were all the top bidders for your PBM contract legacy providers?
Why does this matter?
If your consultant only provided legacy PBM options, there is a conflict of interest. Modern PBMs definitively provide the same level of service at lower overall pharmacy costs. Your RFP process is incomplete without these cost-effective alternatives.
Does your PBM contract include AWP and rebate guarantees?
Why does this matter?
Beware of discount-based contracting. Your discounts may increase every year, and yet your PMPM spend may increase as well. This should not happen, and is a clear indication that your PBM contract is not delivering real cost savings.
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